CDC warns against antibiotic overuse

In an effort to curb growing antibiotic resistance, the Centers for Disease Control and Prevention issued a report on recommended treatment for otitis media, an infection that affects the middle ear. The infection is particularly common in children and is the reported cause of more than 25 million doctor visits each year.

Despite the availability of powerful new antibiotics, such as Pfizer's Zithromax, however, the CDC encouraged pediatricians to stick with an older, generic treatment: amoxicillin.

In a guide to careful antibiotic use posted on its Web site, www.cdc.gov, the CDC recommended that physicians "choose narrow spectrum drugs first" and cited two clinical studies to support the notion that "amoxicillin remains highly effective and is recommended as the first-line antibiotic by most experts."

Second-line therapies suggested by the CDC are Ceftin (cefuroxime), manufactured by Glaxo Wellcome, and Rocephin (ceftriaxone), which is manufactured by Roche.

The rationale behind the CDC's drug recommendations is this: Using more potent antibiotics for otitis media in children may strengthen strains of other infections in their bodies, which, in turn, may make the antibiotics ineffective when children need them to fight stronger, life-threatening infections.

Antibiotic resistance grows

CDC data suggests that worries about overuse of antibiotics are well-founded.

Over the past five years, for example, the rate of penicillin resistance increased by more than 300%, and the rate of cefotaxime resistance increased by more than 1000%.

Pneumococci – the type of bacteria that causes infections such as strep throat – have developed resistance to cephalosporins, erythromycin, trimethroprimsulfamethoxazole, quinolones and other agents.

According to the CDC, the only remaining antibiotic that is effective against all pneumococci is vancomycin.

"Increasing antibiotic use is a likely cause" for this resistance, the CDC stated. The agency went on to ask: "In cases where [antibiotics] are not necessary, is it worth the risk?"

Antibiotic guidelines

Accordingly, the CDC wrote the following guidelines for physicians:

•Â Classify episodes of otitis media as acute otitis media or otitis media with effusion; then, treat only proven acute otitis media. The difference between the two is that one is a viral infection and one is a bacterial infection. Antibiotics are useless and only fuel resistance when used to treat viral infections.

•Â Antibiotics are indicated for treatment of acute otitis media, however, diagnosis requires documented middle ear infection and signs or symptoms of local or systemic illness.

•Â Do not prescribe antibiotics for initial treatment of otitis media effusion.

The CDC also addressed the touchy topic of what physicians should tell parents who demand antibiotics for their ailing children.

To avoid being pressured into prescribing unnecessary antibiotics, the CDC suggested that physicians:

•Â Provide educational materials and share treatment rules with parents to explain when and why the risks of using antibiotics outweigh the benefits.

•Â Build cooperation and trust. Physicians can do this by not dismissing the illness as "only a viral infection;" by walking parents through a treatment plan for symptoms; by giving parents a realistic time course for resolution and by prescribing analgesics and decongestants when appropriate.

According to the agency, avoiding unnecessary treatment of otitis media effusion would prevent between 6 million and 8 million courses of antibiotics each year. PR