Increasing the resistance of microorganisms to antibiotics is a global issue for public health organizations. The increase in resistance is particularly important for Pediatrics due to the frequent use of antibiotics for the treatment of common childhood infectious diseases in outpatient settings and severe infections in hospitals. For example, in various regions of the world, there is an increase in resistance to penicillins and cephalosporins in Streptococcus pneumoniae – the leading etiological agent of meningitis, pneumonia, bacteremia, acute otitis media (OSA) and sinusitis.
The primary risk factors for the formation of infections initiated by penicillin-resistant pneumococci include: age, stay in children’s groups, and a history of inpatient treatment. To date, there has been a significant increase in the frequency of antibiotic use. It is determined that in the United States during 1992 General practitioners prescribed 110 million courses of perroral antibiotics, including 60 million for children under the age of 15. In 1980, 4.206 million amoxicillin prescriptions were made for the treatment of OSO, and in 1992 this figure increased to 12.381 million. (an increase of 194 %). If in 1980 cephalosporins were prescribed for the treatment of OCD only in 876 thousand cases, in 1992 – in 6.892 million. (an increase of 68.7%). It is expected that in 1997, up to 30 million courses of antibiotics will be prescribed for the treatment of CCA, of which at least 50% will be broad-spectrum antibiotics. The most demonstrative example for interpreting the factors of such a dramatic increase in the use of antibiotics in outpatient practice is the treatment of CCA.
First, there is a noticeable increase in the frequency of this disease. Over the past decade, the number of children attending preschool has increased significantly, which is a risk factor for the development of CCA. Second, a number of studies have shown that the system of medical supervision of children has significantly improved. Approximately 90 % of parents confirm that their children are under continuous medical supervision. Improving the organization of medical control is carried out by improving the quality of diagnosis in relatively mild diseases and, as a result, the consumption of perroral antibiotics increases.
At the same time, the frequency of unjustified prescriptions of antibiotics increases accordingly. This is also facilitated by additional work for practicing doctors, on the one hand, and the insistence of parents to prescribe antibiotics for the treatment of their child, on the other. Parents have common misconceptions about the indications for prescribing antibiotics, and often parents use these drugs without the doctor’s knowledge.
There is no doubt that parents are poorly versed in the specific signs of diseases and indications for prescribing antibiotics. For example, if a child has a cold, the doctor diagnosed an ear infection and prescribed an antibiotic for this reason, then parents in most cases are sure that the treatment was prescribed for a cold. To a certain extent, this example reflects the difficulty of detecting the true level of understanding of the problems of antibacterial therapy by parents. Parents often ask doctors to prescribe an antibiotic, thus encouraging their wider use.
Many pediatricians deal with parents who have made incredible efforts to prescribe antibiotics to children with cough, sinusitis, runny nose, non-specific diarrhea, sore throat, i.e. in cases where these drugs are not always indicated. Incredibly, it is often easier for a doctor to write a prescription on request than to engage in lengthy explanations with parents about the etiology and pathogenesis of infections.
Thus, it becomes clear that the tactics of prescribing antibiotics to children by pediatricians are influenced by the requests of parents, a large burden on doctors, as well as false and unfounded considerations.