Expert Commentary

White children more likely to receive unnecessary antibiotics

White children are more likely to receive unnecessary antibiotics for viral illnesses during emergency room visits than their black and Hispanic peers.


White children are more likely to receive unnecessary antibiotics for viral illnesses during emergency room visits than their black and Hispanic peers.

The issue: With viral illnesses like the common cold, there’s little to do other than stock up on tissues and let the symptoms run their course. In an inappropriate but common response, however, doctors sometimes prescribe antibiotics, which are intended to treat bacterial, not viral, infections. A 2016 report from the U.S. Centers for Disease Control and Prevention (CDC) found that 30 percent of antibiotic prescriptions written across the nation were unnecessary.

Not only are antibiotics often an unnecessary treatment for acute respiratory tract infections (ARTIs), but also they are dangerous — bacteria can develop resistance, rendering the medications useless, and patients can experience other health problems such as allergic reactions. Yet the practice persists in various medical situations. A 2017 study indicates that for children, parents’ expectations for antibiotics are partly to blame for their overprescription.

However, different groups experience this problem to varying extents. A 2013 study published in Pediatrics suggests primary care pediatricians give fewer antibiotic prescriptions to black children than to other patients. A 2017 study looks at the issue in the emergency room context.

An academic study worth reading:Racial and Ethnic Differences in Antibiotic Use for Viral Illness in Emergency Departments,” published in Pediatrics, October 2017.

About the study: A team of researchers at the Pediatric Care Applied Research Network (PECARN), a national organization that specializes in emergency medicine, analyzed data collected from seven children’s emergency departments across the country from Jan. 1, 2013 to Dec. 31, 2013. More than 400,000 visits were logged in this time. The team focused on over 39,000 visits that involved patients who were under age 18 and discharged with a single diagnosis of a viral ARTI. The researchers looked at whether or not the patients were given antibiotics, either in the emergency room or upon discharge. They analyzed differences by race and ethnicity, categorizing patients as black, white, Hispanic or other.

Key findings:

  • 2.6 percent of children admitted to emergency departments for viral ARTIs received antibiotics.
  • White children were 1.5 to 2 times more likely to receive antibiotics than Hispanic and black children, respectively; 4.3 percent of white patients received antibiotics, whereas 2.6 percent of Hispanic and 1.9 percent of black patients did. In emergency rooms across the country, these patterns remained constant.
  • While an overall rate of unnecessary antibiotic prescription of 2.6 percent is relatively low compared to other reports documenting this phenomenon, the researchers suggested that the sites chosen might account for this low figure. The study only looked at pediatric emergency rooms, and pediatricians are generally more conservative with antibiotic use for a viral respiratory infection than other types of physicians. Teaching hospitals also prescribe antibiotics more judiciously, and all of the sites were academically affiliated.
  • The researchers stress the significance of the racial differences observed, which they say are part of a larger trend of departing from evidence-based care for white children in the emergency room. The researchers offer a few possible explanations, although they did not investigate further: “race- and ethnicity-specific differences in parental expectations, differential parental pressures perceived by clinicians for treatment of viral infections with antibiotics, and implicit bias of clinicians.”

Other resources:

  • The CDC has a guide to understanding how antibiotic resistance develops and the threats that ensue; we’ve previously covered one.
  • For more on emergency rooms and how they work, the American College of Emergency Physicians offers resources.
  • The Merck Manual, a widely used medical textbook, provides an overview to understanding viral respiratory infections, with explanations of causes, diagnosis and available treatments.

Related research:

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