Experts suspect the difference may stem from over-treatment in white children
TUESDAY, March 19, 2013 (HealthDay News) -- Black children are less likely than other children to be given antibiotics and less likely to be given the most powerful antibiotics to treat acute respiratory tract infections, new research suggests.
Does this represent a previously unrecognized bias against black children? Probably not, said the researchers and other experts. Instead, it's more likely that non-black children are getting more antibiotics than they should be.
"We hypothesize that this discrepancy reflects over-prescribing, both for all antibiotics and for the relative proportion of broad-spectrum antibiotics, to non-black patients, rather than under-prescribing to black patients," wrote the researchers led by Dr. Jeffrey Gerber, of the Children's Hospital of Philadelphia, who added that more study of this pattern should be conducted.
Dr. Allison Bartlett, a pediatric infectious disease specialist at LaRabida Children's Hospital in Chicago, agreed. "The fact that black kids are given fewer antibiotics and fewer broad-spectrum antibiotics may come across as a bad thing to the casual reader, but perhaps it's not an issue of under-treating black kids, but over-treating non-black kids," she said.
Another expert who was not involved with the study, Dr. Roya Samuels, a pediatrician at Cohen Children's Medical Center in New Hyde Park, N.Y., said that, at first glance, "this comes across as quite a controversial topic. But, I don't think we're dealing with a predilection to not prescribing to black children. Rather, there is still non-judicious use of antibiotics in the pediatric population as a whole, and non-judicious use tends to occur more in the non-black population."
Results of the current study were released online March 18 and will appear in the April print issue of Pediatrics.
Gerber and colleagues undertook the study because racial disparities have been found in other areas of health care, but the issue hadn't been thoroughly studied in a pediatric primary care setting, according to background information in the report.
The study included data from 25 primary care pediatric practices in Pennsylvania and New Jersey. The practices had a total of 222 doctors.
From a total of more than 600,000 office visits, the investigators found that there were more than 100,000 visits that included a prescription for an antibiotic. To help account for factors that might influence the way a physician chose to treat a particular patient, the researchers excluded visits for people with antibiotic allergies and those who'd had a recent history of antibiotic use from their data.
That left just over 81,000 visits that ended with an antibiotic prescription. Almost 30,000 of those visits ended with a prescription for a broad-spectrum antibiotic, which means a powerful antibiotic that kills a variety of bacteria. In general, antibiotic use recommendations suggest using the most narrow-spectrum antibiotic possible to help prevent antibiotic resistance.
When the researchers broke the data down by race, they found that 29 percent of visits by non-black children ended with an antibiotic prescription compared to 23.5 percent for black children. When an antibiotic was prescribed, black children were about 12 percent less likely to receive broad-spectrum antibiotics.
Black children were also less likely to receive a diagnosis that might justify an antibiotic prescription, such as strep throat, a sinus infection or an ear infection. Both Bartlett and Samuels said that they were a bit confused by the strep throat findings, as an objective test is available to diagnose strep. The study authors said they were not aware of any biological reasons that could account for these findings. All of the experts suggested this was an area that needed further research.
The authors said that the doctor-patient relationship may play a role in some of these findings. Parents of non-black children may state that they expect antibiotics more often, or doctors may expect that these parents will want antibiotics for their child, which may influence their prescribing decisions, they suggested.
Both Samuels and Bartlett said that black parents probably don't need to be concerned by these findings. But, Bartlett added that all parents should "be strong advocates for their children. We're very fortunate that we have antibiotics to help when we need them, but there are a lot of times we don't need them, and we need to give a child's body time to heal on its own."
It's OK to ask your child's doctor why he or she is prescribing an antibiotic, or why not, according to Samuels.
"Physicians are your partners," said Samuels. "They're healers and teachers, and parents need to understand the thinking behind a clinical decision. Parents also need to know that every medication can potentially cause an allergic reaction and every medication can have adverse effects. Antibiotics need to be prescribed with great care and thought," she said.
Learn more about appropriate antibiotic use from the U.S. Centers for Disease Control and Prevention (http://www.cdc.gov/GETSMART/ ).
SOURCES: Allison Bartlett, M.D., consulting physician, infectious diseases, LaRabida Children's Hospital, and associate director, infection prevention program, and associate director, antimicrobial stewardship, University of Chicago; Roya Samuels, M.D., pediatrician, Cohen Children's Medical Center, New Hyde Park, N.Y.; April 2013, Pediatrics