TOO MUCH OF A GOOD THING? HOW PARENTS CAN AFFECT THEIR KIDS' HEALTH BY OVERMEDICATING.

Byline: Janet Zimmerman Staff Writer

It's the same thing every flu season: Desperate parents take their sick children to the doctor and plead for antibiotics because they want them to feel better fast. Sometimes parents are so insistent that doctors relent, even when it's not clear antibiotics are not warranted, health officials say.

``We don't want to end up back in antibiotic resistance,'' said UCLA pediatrician Dr. Rita Mangione-Smith. ``That's where we're heading.''

The problem has become so serious the Centers for Disease Control and the California Medical Association Foundation have launched public- education campaigns.

The Sacramento-based Alliance Working for Antibiotic Resistance Education (AWARE) has launched a long-term state-wide effort to reduce the inappropriate use of antibiotics.

Mangione-Smith has been awarded a four-year, $240,000 grant to from the Robert Wood Johnson Foundation to study how parents may influence doctors in the over-prescribing of antibiotics.

Many parents will go to their doctor and demand an antibiotic believing they are taking a positive step toward helping their child get better faster. The fact is, up to 50 percent of antibiotics are used inappropriately and that does more harm than good, said Elissa Maas, project director of the state medical association's campaign.

But Mangione-Smith says the over-prescribing isn't necessarily caused by pushy parents stalking into offices and demanding antibiotics that their kids don't need. A pilot study conducted by Mangione-Smith examining the relationship between parents' expectations and the prescribing habits of pediatricians showed that parents rarely made direct requests.

``I don't think that's the problem,'' said Mangione-Smith whose pilot study was published in the journal Pediatrics in April of 1999. ``The nature of the doctor/patient relationship is that most parents and patients are pretty timid. If there is pressure being applied, it's being done much more indirectly.''

In California, 30 percent of infections are resistant to drugs. Ear infections, routine among children, now require three or four times the usual does of amoxicillin to kill the bacteria, doctors say. Life-threatening infections such as meningitis are also growing less treatable with antibiotics. Drug-resistant infections are more likely to require hospitalization.

``There's been a general overuse of antibiotics for years and years. It's a huge problem,'' said Dr. Mary Mailander, a Redlands pediatrician. ``Every year I see more and more resistant infections.''

Essentially, bacteria are practicing survival of the fittest: Those that aren't killed become stronger. More powerful antibiotics must then be used to kill the bacteria, if it can be killed at all.

Because children younger than 5 are so frequently doused with antibiotics, they have the highest rate of antibiotic-resistant infections of any age group - as much as twice that of 20- to 40-year-olds.

Children also face the greatest risk of running out of effective antibiotics, said Ronald Jones, a microbiologist with the Sentry Antimicrobial Surveillance program at the University of Iowa.

``One of the problems that a lot of parents have these days is that with children in daycare, the parents are not allowed to bring children with green runny noses. To many people in the daycare setting, that signifies the need for antibiotics. These poor parents are between a rock and a hard place,'' Mailander said.

There is hope in the form of a newly approved vaccine against pneumococcal, the deadliest bacteria responsible for middle-ear infections, pneumonia and meningitis. In February, the CDC' Advisory Committee on Immunization Practices recommended it for all children younger than 2. A couple of the most effective vaccines can only be applied intravenously or through an intra-muscular shot, meaning they'll be especially invasive and painful.

Preschool children average four to eight colds per year, studies show. About 70 percent of their upper respiratory infections are caused by viruses and clear up on their own.

But almost half the children diagnosed with these viral infections get prescriptions for antibiotics - even though antibiotics kill only bacteria and are ineffective against viruses.

Mangione-Smith believes parents demanding antibiotics for their kids is not the norm. Several years ago, she read an article published by the American Academy of Pediatrics that placed the blame of antibiotic over-prescription squarely on parents.

``It indicated that if the parents would stop pressuring us, we'd stop doing the wrong thing and it would all go away,'' said Mangione-Smith. ``It became pretty clear that there had been no systematically done studies that looked at how parents' expectations influenced prescribing patterns. I was reading people's opinions.''

Battling all those bugs

Here are some ways to help prevent development of antibiotic-resistant infections, according to the California Medical Association Foundation:

--Take your prescribed antibiotic for the full course of treatment.

--Do not use leftover antibiotics or when not under a doctor's care.

--Do not insist on an antibiotic prescription when your doctor says no. Antibiotics cannot kill viruses, which include all colds and flu and most coughs and sore throats. Antibiotics can be effective for treating bacterial infections such as strep throat, urinary tract infections, most ear infections and some sinus infections.

- Staff Writer Evan Henerson and wire services contributed to this report.

CAPTION(S):

2 photos, box

Photo:

(1 -- cover -- color) Antibiotic overkill 

Parents and doctors beware: By giving kids pills they don't need we're spawning bugs we can't fight.

(2) ``It became pretty clear that there had been no systematically done studies that looked at how parents' expectations influenced prescribing patterns,'' says Dr. Rita Mangione-Smith about her need for conducting her own antibiotic research.

Hans Gutknecht/Staff Photographer

Box: Battling all those bugs (see text)