Nearly half of children seen by physicians for treatment of a common cold leave their doctors' offices with unnecessary prescriptions for antibiotics. Bacteria-fighting antibiotics are useless against colds, the vast majority of which are caused by viruses. Nonetheless, "antibiotics were prescribed to 44% of (pediatric) patients with common colds. The unnecessary overprescription of antibiotics during past decades has been blamed for the recent emergence of antibiotic-resistant strains of sometimes deadly bacteria.

The researchers say children aged 5 to 11 years were nearly twice as likely as younger children to receive an antibiotic prescription during a cold-related office visit. They speculate that parents of school-aged children may put more pressure on physicians to prescribe antibiotics because these parents "often do not have mechanisms in place to care for their child at home, (and) they may perceive antibiotic treatment as reassurance that 'everything possible is being done' and feel more comfortable returning the child with a respiratory illness back to school.

The accompanying editorial authors believe managed care company policies may be contributing to the problem. They speculate that patients who wrongly believe antibiotics will speed recovery may be pressuring doctors for prescriptions. Once they receive these prescription, patients then give compliant doctors higher marks on health maintenance organization satisfaction surveys. Managed care administrators use those surveys to evaluate -- and reward -- individual physicians.

The Journal of the American Medical Association (1998;279:875-877, 881-882)

COMMENT: Yet another article confirming antibiotic abuse. I wonder if there is going to be such an accepted truth that they will stop publishing these articles. The interesting component of this article is the speculation that HMO are partly responsible by indirectly pressuring physicians to cater to uninformed patients who request antibiotics when not indicated. (also see last issue #40)