White children receive antibiotics for viral illness at a higher rate than black or Hispanic children
White children with viral diagnoses treated in pediatric emergency departments were up to twice as likely to receive antibiotics compared to minority children, according to a study published in Pediatrics. Although viral respiratory tract infections do not warrant antibiotic treatment, antibiotics were prescribed for these illnesses to 4.3 percent of white, 1.9 percent of black and 2.6 percent of Hispanic children.
“Our study is the first to report racial and ethnic differences in unnecessary antibiotic use for treatment of viral infections in the emergency departments,” says senior author Elizabeth R. Alpern, MD, from Stanley Manne Children’s Research Institute at Ann & Robert H. Lurie Children’s Hospital of Chicago and faculty at the Northwestern University Institute for Public Health and Medicine. “Similar differences have been observed in the primary care setting, and we need a better understanding of why this occurs.”
Using the Pediatric Emergency Care Applied Research Network Registry, Alpern and colleagues examined electronic health data from 39,445 encounters for viral acute respiratory tract infections at seven pediatric emergency departments.
While it was beyond the scope of the study to investigate the reasons for racial and ethnic differences in antibiotic overprescribing, the authors suggest that potential reasons may include differences in parental expectations and pressures perceived by clinicians to treat children with antibiotics. Implicit bias of clinicians may also contribute to the phenomenon.
“We know from previous studies, racial and ethnic differences that favor white children over minority children may be due to caregiver’s or provider’s perception that more is better, even when more is not clinically indicated as is the case with antibiotic use for viral illnesses,” says Alpern, an Emergency Medicine physician at Lurie Children’s and a Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “More research is needed into the drivers of racial and ethnic differences to help achieve health equity and reduce antibiotic overprescribing.”
Nationally, more than 80,000 antibiotic prescriptions for viral acute respiratory infections are written in emergency departments each year, according to the Agency for Healthcare Research and Quality.
“Inappropriate use of antibiotics contributes to the development of antibiotic resistant bacteria,” says Alpern. “It is critical for all of us to be reminded that antibiotics do not work for viral illnesses and should be not be used in these cases.”
This work was supported by an Agency for Healthcare Research and Quality R01 award HS020270 (Alpern); Health Resources and Services Administration, Maternal and Child Health Bureau, Emergency Medical Services for Children Network Development Demonstration Program under cooperative agreements U03MC00008, U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC22684, and U03MC22685 (Pediatric Emergency Care Applied Research Network); Eunice Kennedy Shriver National Institute of Child Health and Human Development K23 award HD070910 (Goyal). The funding sources had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript. Funded by the National Institutes of Health (NIH).