May 25th, 2011
When should doctors prescribe antibiotics to treat asthma? “The answer in 2011 is that they shouldn’t,” says Ian M. Paul, M.D., associate professor of pediatrics at the College of Medicine at Penn. State. Yet Paul and his colleagues have found that doctors do – about a million times a year.
Their study, published online May 23 and in print in the June issue of Pediatrics, looked at more than 60 million cases where children across the U.S. visited their doctors or the emergency room for asthma treatment from 1998 to 2007. They found that antibiotics were prescribed inappropriately at as many as 1 in 6 of these visits.
Healthcare experts have long been concerned about the over-prescribing of antibiotics because it can lead to the evolution of bacteria that is antibiotic resistant. The only time children with asthma should receive antibiotics is if they have an additional diagnosis – maybe a bacterial infection such as pneumonia – where the drugs would be needed.
Based on this study, researchers couldn’t determine why exactly doctors ignore guidelines and prescribe antibiotics for asthma. But they did note that children who received systemic corticosteroids (indicating a more severe attack) to treat their asthma were also more likely to receive antibiotics. “I can surmise from that that those kids were sicker, and the doctor wanted to throw the kitchen sink at it,” says Paul. Also, because asthma and pneumonia share some signs and symptoms, it is possible doctors prescribe antibiotics when they aren’t certain of their diagnosis.
Surprisingly to Paul, this is less likely to happen in emergency departments than at the doctor’s office, though the study offers no clues as to why. But in either type of visit, discussion with the doctor is key. “We found that when the doctors spent the time to educate families about asthma, they were 50% less likely to prescribe antibiotics,” Paul says. So parents should ask a doctor prescribing antibiotics to their asthmatic child what the medication is supposed to treat. If the doctor seems uncertain about the diagnosis, it’s reasonable to ask about a 24-hour waiting period to see whether asthma medications help with your child’s symptoms. “It’s really about communication with your doctor,” Paul says. Either way, ultimately, you’ve got to trust your doctor, so make sure your doctor is someone you trust.