UNIVERSITY PARK, Pa. — A one-year, $322,876 grant from the U.S. Centers for Disease Control and Prevention (CDC) will enable researchers from the Penn State Department of Communication Arts and Sciences to evaluate antibiotic prescriptions for childhood ear infections, examine doctor-parent conversations about the use of antibiotics, survey parents’ attitudes toward antibiotic use, and, ultimately, identify effective communication strategies that reduce the overuse of antibiotics in treating pediatric illness.
Erina MacGeorge and Rachel Smith, associate professors of communication arts and sciences, will work with colleagues in the Penn State College of Medicine and the Pennsylvania Department of Health on three related studies.
One study will examine current rates of “watchful waiting” (as opposed to the immediate prescribing of antibiotics) for children suffering from pediatric acute otitis media, more commonly referred to as an ear infection. In the second study, researchers will observe clinical interactions between doctors and parents of pediatric patients to identify communication techniques that promote understanding and encourage acceptance of “watchful waiting” as a treatment option. The third study, a large-scale survey of Pennsylvania parents, will examine parents’ attitudes about antibiotic treatment and will be used to design campaigns to promote appropriate use before parents seek treatment for their children.
This project is one of 34 recently funded through the CDC’s Antibiotic Resistance Solutions Initiative, which seeks to discover and develop new ways to prevent and reduce the spread of antibiotic-resistant infections. Although antibiotics have been a critical public health tool since the discovery of penicillin in 1928, the emergence of drug resistance in bacteria is reversing the effectiveness of many antibiotics — thereby making drug choices for the treatment of many bacterial infections increasingly limited, expensive, and, in some cases, nonexistent. The CDC estimates that drug-resistant bacteria cause 2 million illnesses and approximately 23,000 deaths each year in the United States alone.
The over-prescribing and overuse of antibiotics for outpatient conditions is a significant contributor to the reduction in their effectiveness.
“Antibiotics are life-saving medicines, but the overuse of antibiotics threatens their future effectiveness through the selection of resistance,” said Clifford McDonald, associate director of science for CDC’s Division of Healthcare Quality Promotion. “As a means to promote the better use of antibiotics, [the Penn State] project is an example of applied research that has the potential to produce innovative public health approaches to better combat antibiotic resistance.”
At present, unnecessary prescribing of antibiotics for acute otitis media is especially high. Clinical guidelines for pediatricians recommend “watchful waiting” as the approach for treating non-severe acute otitis media in children aged six months and older. However, parents and other caregivers often resist this approach for treating their children.
“Parents are worried for their children; they often do not understand that antibiotics provide little if any benefit and carry significant risks, including side effects, allergic reactions, and the development of antibiotic resistance,” MacGeorge said. “Parental pushback increases the pressure on health care providers to prescribe antibiotics when they should not.
“That’s why we need research — to help doctors and parents work together to reduce antibiotic use. In addition to understanding why antibiotics should be avoided whenever possible, parents need to understand how to carry out ‘watchful waiting.’ This includes understanding how to reduce children’s discomfort with over-the-counter medication and how long to wait to see if symptoms persist. In most cases, the child’s body will successfully defeat the infection without antibiotics; however, parents also need to know how to monitor their child and obtain follow-up care if needed.
“By highlighting the ways antibiotics are currently being utilized, identifying ways that physicians can improve their advising strategies, and illuminating the approach needed to change the stewardship behaviors of parents and other pediatric caregivers, we hope to reduce the over-prescribing of antibiotics and slow the growth of antibiotic-resistant infections.”
Additional information about the CDC Antibiotic Resistance Solutions Initiative can be found at https://www.cdc.gov/drugresistance/solutions-initiative/index.html. To learn more about the Penn State study, contact MacGeorge at elm26@psu.edu.
Note: Co-investigators from the Penn State College of Medicine and Pennsylvania Department of Health have purposefully not been named in this article to avoid identifying the clinical site and thereby preserve the integrity of the studies.