Putting Antibiotic Prescribing for Children Into Context

Prescribing antibiotics judiciously is becoming universally embraced as a virtue by clinicians. The goal is to avoid antibiotics when no clear benefit exists and to use agents that best balance the benefits and risks to the individual as well as population-level effects such as promotion of antibiotic resistance. For children in particular, the decrease in rates of antibiotic use since the early 1990s represents an underappreciated public health success story. The decline in antibiotic use for young children with acute respiratory tract infections (ARTIs) of 36% over a decade¹ represents a remarkable shift in clinical practice. It is difficult to connect this with a particular guideline, intervention, or campaign. However, most of this change has been driven by decreases in the diagnosis of otitis media in young children¹ coincident with focused attention by the Centers for Disease Control and Prevention,² guidelines from professional societies,³ and introduction of new vaccines that likely had small but important effects on the incidence of otitis media.⁴