Promoting appropriate antibiotic use for pediatric patients: a social ecological framework

https://doi.org/10.1053/j.spid.2004.01.004Get rights and content

Abstract

During the 1990s, the number of prescriptions for antibiotics for children and adolescents finally decreased after more than a decade of alarming increases. The Centers for Disease Control and Prevention (CDC) and many other groups have designed and implemented interventions to promote appropriate prescribing of antibiotics, and these efforts appear to have contributed to recent decreases in rates of such prescribing. In this article, we describe the various types of interventions that the CDC and others are using to encourage appropriate use of antibiotics. A social ecological framework is used to describe the various factors contributing to prescribing and using antibiotics, as well as the interventions used for targeting these factors. Although most efforts promoting appropriate use of antibiotics have focused on reducing such use for viral infections, future efforts also should include a focus on ensuring the use of targeted agents when antibiotics are indicated.

Section snippets

A social ecological framework for promoting appropriate antibiotic use

The social ecological approach to promotion of health recognizes the contributions of both individual influences (eg, knowledge, attitudes, and skills) and social environmental influences (eg, social norms and organizational policies and practices) on health behavior.15, 16, 17 This approach integrates person-focused efforts to modify people’s health behavior with environment-focused interventions to enhance their physical and social surroundings.18 The use of an ecological framework such as

CDC’s national campaign activities

In 1995, the CDC launched the Campaign for Appropriate Antibiotic Use in the Community.10 This campaign aims to reduce the spread of antibiotic resistance by: 1) promoting adherence among providers to guidelines for appropriate prescribing, 2) decreasing demand for antibiotics for viral upper respiratory infections among healthy adults and parents of young children, and 3) increasing adherence to prescribed antibiotics for upper respiratory infections. The campaign targets the 5 respiratory

Decreasing use of antibiotics for acute otitis media (AOM)

Otitis media accounted for more than one-third of all antibiotics prescribed in physician offices for children and adolescents younger than 15 years in 1999 to 2000.3 In assigning diagnoses, clinicians rarely distinguish between acute otitis media (AOM) and otitis media with effusion.12 This distinction is important because antibiotics are recommended routinely for AOM but are not recommended for otitis media with effusion. The CDC/AAP principles clarify the diagnostic criteria for AOM, but no

What can health care providers do?

Healthcare providers play a key role in efforts aimed at establishing appropriate use of antibiotics for their pediatric patients. The CDC guidelines provide details about the diagnosis and treatment of common pediatric respiratory conditions (Table 2).6 Most often used to guide establishing a diagnosis and making treatment decisions, the guidelines also can be used as a catalyst for discussing local resistance patterns or effective strategies among providers in a practice or other community

Summary

The use of antibiotics drives antibiotic resistance. Overall, rates of prescribing antibiotics for children declined during the 1990s. Several community interventions have achieved reductions in rates of prescribing antibiotics, thereby helping to slow the further spread of resistance and to protect the strength of future antibiotics. A social ecological framework can be helpful in focusing interventions on both the individual and social environmental factors that determine antibiotic use and

Acknowledgements

The authors acknowledge Linda McCaig, MPH, for data analysis and for review of sections of the manuscript.

References (35)

  • M.R. Reichler et al.

    The spread of multiply resistant Streptococcus pneumoniae at a day care center in Ohio

    J Infect Dis

    (1992)
  • S.F. Dowell et al.

    Resistant pneumococciprotecting patients through judicious use of antibiotics

    Am Family Phys

    (1997)
  • C.L. Emmer et al.

    Combating antimicrobial resistanceintervention programs to promote appropriate antibiotic use

    Infect Med

    (2002)
  • G. Schwartz et al.

    US counties with higher rates of antibiotic use have significantly higher proportions of beta lactam and macrolide nonsusceptible S pneumoniae antimicrobial resistance

    (1998)
  • R.E. Besser

    Promoting appropriate antibiotic use for otitis mediaa public health perspective

  • L.F. McCaig

    Personal communication

    (2003)
  • R.E. Besser

    Antimicrobial prescribing in the United Statesgood news, bad news

    Ann Intern Med

    (2003)
  • Cited by (0)

    View full text