American Academy of Pediatrics
Winner of Outstanding Chapter Award 1966, 1996, 2000 & 2004
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Georgia
Chapter American Academy of Pediatrics Winner of Outstanding Chapter Award 1966, 1996, 2000 & 2004 |
The increasing prevalence of antimicrobial resistance
remains an issue of concern to patients as well as health care
professionals. Highly
resistant pathogens may not be treatable with available antimicrobials. At the very
least, resistant pathogens increase
expense, complicates therapy and makes
treatment failure more likely. Resistant
pathogens can be food-borne, community-acquired or hospital-acquired. Among community-acquired and hospital-acquired pathogens, the
increased prescribing and use of antimicrobials is largely responsible for
the increase in resistance.1 From 1980 - 1990, antimicrobial prescribing rates for children
in office-based practices in the United States increased 48%.
Alarmingly, the rates of antimicrobial resistance rose as well.2
The majority of antimicrobial prescriptions are written for the treatment
of respiratory infections. In
fact, approximately 3/4 of all outpatient prescriptions written for
children are for 5 conditions: otitis media, sinusitis, cough
illness/bronchitis, pharyngitis and nonspecific upper respiratory tract
infection (the common cold).1,2
Treated with an antimicrobial, a child runs the risk of becoming a
carrier of resistant bacteria.
In response to agreement that antimicrobial use leads to drug resistant
pathogens, the Centers for Disease Control and Prevention (CDC) partnered
with professional organizations including the American Academy of
Pediatrics (AAP) to address this concern.
Their goals were to develop educational and behavioral
interventions to modify drug prescribing habits of physicians and educate
parents/patients about the appropriate use of antimicrobials, to develop
guidelines for the appropriate use of antimicrobials, to evaluate the
impact of vaccine use in the prevention of drug resistant disease, to
promote infection control strategies and improve the accuracy and
timeliness of detecting antimicrobial resistance at the practice level.2
In 1998, the CDC and the AAP co-sponsored "Principles of 
Judicious Use of Antimicrobial Agents: A Compendium for the Health Care
Professional." This
compendium is a collection of six articles providing principles of
judicious antimicrobial
use supported by evidence-based publications.
It also includes other relevant articles and patient education
materials.3 In
addition to the compendium, the AAP offers practice guidelines on
sinusitis and otitis media with effusion www.aap.org/policy/paramtoc.html
and an online learning module on otitis media (case studies and
pneumatic otoscopy).
Guard: Georgia United Against Resistant Disease
Acknowledging that inappropriate antimicrobial
prescribing and use was multi-factorial, the CDC partnered with national
and state organizations to produce educational materials for
patients/parents and physicians, provide guidance and support to
physicians for more accurate diagnose and prescribing habits, and increase
awareness of the need to save antibiotic strength.
In 2002, Georgia received a grant from the CDC to organize a
coalition as a broad-based effort to reduce the spread of antimicrobial-resistant
disease and decrease inappropriate prescribing of antimicrobials.
Georgia United
against Antibiotic Resistant Disease (GUARD) goals are to 1) change
consumer awareness, understanding and behavior regarding responsible use
of antibiotics, 2) optimize
physician behavior regarding the appropriate use of antibiotics to treat
infectious disease, and 3) reduce the incidence of antibiotic-resistant
disease and thereby save antibiotic strength.
GUARD is a collaboration of professional, academic, community,
government, labor and industry partners committed to decreasing the
incidence of antimicrobial- resistant pathogens in Georgia.
Visit the GUARD website (www.guard-ga.org
)for information about GUARD, educational information for adults, kids,
medical community and day care, and for free office resource materials.
GUARD has developed the following materials for use in your clinic or office:
Prescription Pads for viral illness (providing suggestions for relief of symptoms)
School/Day Care Excuse note pads
Brochures for parents and adults (educating about viral illness and appropriate antibiotic use)
Refrigerator Magnets
Bookmarks
To order contact:
Anna Vickery, MHSE, CHES
GUARD Coalition
(706) 721-7396
Karen Townsend, RN
Georgia Chapter
American Academy of Pediatrics
(404) 881-5081
In September, 2003, the CDC launched their "Get
Smart" campaign to reduce the incidence of antimicrobial-resistant
disease by "knowing when antibiotics work."
Recommendations
for appropriate antibiotic use for health care providers:
Visit the "Get Smart" website for educational information and resource materials for your office or clinic. (download or purchase) www.cdc.gov/getsmart
A recently published study by Dr. Jonathan A. Finkelstein and associates of Harvard University using claims data from nine health plans found that the rate of antibiotic use among children declined for the years 1996-2000. Researchers suggested that the decline is due mostly to the efforts of the CDC and its partners to educate physicians and the public about the dangers associated with overuse of antibiotics.4
Robert M.
Siegel, MD and associates conducted a study to find out if parents would be
comfortable with managing acute otitis media by using pain control and having
a 'safety net antibiotic prescription' available.
Called SNAP (safety net antibiotic prescription), this method was found
to be accepted by parents and helped to reduce antibiotic usage.
The study was conducted in the Midwest at practices associated with the
Cincinnati Pediatric Research Group. Of the 194 children enrolled in the
study, 175 completed follow-up interviews resulting in the following findings:
31% had filled the prescriptions, 78% of the parents reported the pain
medication was effective and 63% were willing to try future episodes of acute
otitis media with pain medication alone.5
The number of pediatric soft tissue infections caused by community-acquired, methicillin-resistant strains of Staphylococcus aureus (MRSA) dramatically increased from 2002 to 2003 at Children's Hospital of Philadelphia. By 2003, half of all community-acquired S. aureus soft tissue infections seen at the hospital were methicillin-resistant. This rising incidence of community-acquired infections with methicillin-resistance is a trend seen in reporting centers across the country. Another important feature of the MRSA infections is that many of the isolates were multidrug resistant - 53% resistant to ciprofloxacin and 93% resistant to erythromycin. For invasive infections with S. aureus the number remained steady at about 15%.6
Georgia Epidemiology Report June 2004: The number of infections involving community acquired methicillin-resistant Staphylococcus aureus (CAMRSA) rose from 4% in 2001 to 8% in 2002 (among isolates from any culture taken within 48 hours after hospital admission where the patient had no previous history of MRSA infection or colonization, no history of percutaneous device or indwelling catheter, no history of dialysis, surgery, hospitalization or residence in a long term care facility in the past year). Some Georgia populations affected by community-acquired methicillin-resistant S. aureus include inmates in correctional facilities, athletes participating in team sports, neonates, military and families. Cases of severe disease or death from CAMRSA are in the works to be added to the public health list of notifiable diseases. Any clusters of this disease should be reported to the state. 7
Need a reference book for parents? Try "Breaking the Antibiotic Habit: A parent's guide to coughs, colds, ear infections, and sore throats." Paul A. Offit, MD; Bonnie Fass-Offit, MD & Louis M. Bell, MD. Published in 1999 by John Wiley & Sons, this book contains information about antibiotics, appropriate use of antibiotics, bacterial versus viral infections and over-the-counter medications.
1 American Academy of Pediatrics. [Appropriate
Use of Antimicrobial Agents]. In Pickering, LK, ed. 2003
Red Book: Report of the Committee on Infectious Diseases, 26th
edition. Elk Grove Village, IL: AAP, 2003. P. 695-97.
2
McCaig, L., Besser, R. & Hughes, J.
(2002). "Trends
in antimicrobial prescribing rates for children and adolescents."
Journal of the American Medical Association, 287(23).
P. 3096-3102.
3 American Academy of Pediatrics. (1998). "Principles of judicious use of antimicrobial agents: A compendium for the health care professional." Pediatrics, 101(1), supplement.
4 Finkelstein,
J., Stille, C., Nordin, J., Davis, R., Raebel, M., Roblin, D., Go, A.,
Smith, D., Johnson, C., Kleinman, K., Chan, K. & Platt, R.
(2003). "Reduction
in antibiotic use among US children."
Pediatrics, 112(3). P. 620-627.
5 Siegel, R., Kiely, M., Bien, J., Joseph, E., Davis, J., Mendel, S., Pestian, J., & DeWitt, T. (2003). "Treatment of Otitis Media with Observation and a Safety-Net Antibiotic Prescription." Pediatrics, 112(3), 527-531.
6 Zoler, M. 'Study in Philadelphia: Methicillin-resistance soars in comunity-acquired S. Aureus.' Pediatric News, 38(6).
7 Tobin-d'Angelo & Arnold, K. (2004). "Community-Associated Methicillin resistant Staphylococcus aureus (MRSA).". The Georgia Epidemiology Report, 20(06).