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Diarrheal Illness in Children Linked to Antibiotics

CDC urges physicians to improve prescribing practices to reduce harm

Most of the pediatric Clostridium difficile infections, which can cause severe diarrhea and are potentially life-threatening, occur among children in the general community who recently took antibiotics prescribed in doctor’s offices for other conditions, according to a new study by the Centers for Disease Control and Prevention (CDC) published in Pediatrics.

The study showed that 71% of the cases of C. difficile infection identified among children aged 1 through 17 years were community-associated — that is, not associated with an overnight stay in a health care facility. By contrast, two-thirds of C. difficile infections in adults are associated with hospital stays.

Among the community-associated pediatric cases whose parents were interviewed, 73% were prescribed antibiotics during the 12 weeks prior to their illness, usually in an outpatient setting, such as a doctor’s office. Most of the children who received antibiotics were being treated for ear, sinus, or upper respiratory infections. Previous studies have shown that at least 50% of antibiotics prescribed in doctor’s offices for children are for respiratory infections, most of which do not require antibiotics.

“Improved antibiotic prescribing is critical to protect the health of our nation’s children,” said CDC Director Tom Frieden, MD, MPH. “When antibiotics are prescribed incorrectly, our children are needlessly put at risk for health problems including infection and dangerous antibiotic-resistant infections.”

President Obama’s budget for fiscal year 2015 requests funding for CDC to improve outpatient antibiotic prescribing practices and to protect patients from infections, such as those caused by C. difficile. The CDC initiative aims to reduce outpatient prescribing by up to 20% and health care-associated C. difficile infections by 50% in 5 years. A 50% reduction in health care-associated C. difficile infections could save 20,000 lives, prevent 150,000 hospitalizations, and cut more than $2 billion in health care costs, the agency says.

C. difficile, which causes at least 250,000 infections in hospitalized patients and 14,000 deaths every year among children and adults, remains at all-time high levels. According to preliminary CDC data, an estimated 17,000 children aged 1 through 17 years are infected with C. difficile every year. The new study found that there was no difference in the incidence of C. difficile infection among boys and girls, and that the highest numbers were seen in Caucasian children and those between the ages of 12 and 23 months.

Taking antibiotics is the most important risk factor for developing C. difficile infections for both adults and children, the CDC says. When a person takes antibiotics, beneficial bacteria that protect against infection can be altered or even eliminated for several weeks to months. During this period, patients can get sick from C. difficile picked up from contaminated surfaces or spread from a health care provider’s hands.

Although there have been significant improvements in antibiotic prescribing for certain acute respiratory infections in children, further improvement is greatly needed, the CDC says. In addition, it is critical that parents avoid asking doctors to prescribe antibiotics for their children and that doctors follow prescribing guidelines.

Source: CDC; March 7, 2014.

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