CURRENT ISSUES

Many respiratory tract infections rarely need antibacterials

Many courses of antibacterials are prescribed unnecessarily in children and contribute to the spread of antibacterial resistance, says Dr Benjamin Schwartz, chief of childhood and vaccine preventable diseases at the Centers for Disease Control and Prevention in Atlanta, US.

Antimicrobial resistance - an increasing problem

Dr Schwartz estimates that about 33% of all antibacterial prescriptions are written unnecessarily per year. Overuse of antibacterials is the 'leading fwtar contributing tn thf' sprPnd nf antimicrobial resistance', he says. In particular, the development of resistance to Streptococcus pneumoniae is a significant problem. The resistance of S. pneumoniae strains against penicillin and cefotaxime has increased by> 300 and 1000%, respectively. In 1997, > 8% of pneumococcal strains were not susceptible to oral formulations of amoxicillin, azithromycin, erythromycin or cotrimoxazole. Therefore, some common infections, such as otitis media or sinusitis, may soon require parenteral treatment. Furthermore, some enterococcal pathogens are now resistant to any licensed antibacterial.

Antibacterials not warranted Dr Schwartz notes that in healthy individuals, the

use of antibacterials is not necessary for the following common illnesses: otitis media with effusion; viral rhinitis; viral 'inusitis; nonstreptococcal pharyngitis: cough; and acute bronchitis.

However, Dr Schwartz suggests that antibacterials may be indicated for: • proven acute otitis media • mucopurulent rhinitis if persistent for> I 0-14 days

without improvement • persistent acute sinusitis with prolonged nonspecific

or severe upper respiratory tract signs and symptoms

• group A streptococcal pharyngitis

• prolonged cough(> 10 days), for example in children with pertussis, Mycoplasma pneumoniae infection and children with underlying chronic pulmonary disease.

Dr Schwartz suggests that the following factors should be considered when selecting an antibacterial: activity, licensed indications, potential adverse events, infection severity, cost, ease of dosing, taste and the impact of therapy for resistant pathogens. Reducing antimicrobial resistance: five common illnesses that do not warrant antibiotic use. Formulary 34: 67-68. Jan 1999 •om39m

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PharmacoEconom1cs & Outcomes News 27 Feb 1999 No. 201