Excessive Antibiotic Use Common in Poorer Families

Parents with Medicaid insurance were more likely to overuse antibiotics than parents with commercial insurance, according to a new study.

Researchers at the Oregon Health & Science University (OHSU; Portland, USA), Tufts Medical Center (Boston, MA, USA), and other institutions conducted a survey during Spring of 2013 among 1,500 parents in the state of Massachusetts (USA) with a child six years old or younger who were insured by Medicaid managed care or a commercial health plan. The researchers assessed antibiotic-related knowledge and attitudes in relation to sociodemographic predictors, evaluating changes since a similar survey in 2000.

The survey indicated Medicaid-insured parents in 2013 were younger, were less likely to be white, and had less education than those commercially insured. Overall, a larger portion of Medicaid parents would rather give my child an antibiotic than wait and see if he or she needed it, compared to parents with commercial insurance (6% versus 21%, respectively). Parents with Medicaid also had increased knowledge gaps on the appropriateness of antibiotic use. For example, they were less likely to know that antibiotics are almost never used to treat colds or flu (44% versus 78%) and almost never used for runny nose or green nasal discharge (38% versus 53%).

Compared to parents with commercial insurance, Medicaid parents were also more likely to agree with statements such as “I will take my child to another doctor for an antibiotic if I don't receive one” (23% versus 9%), and “If I expect an antibiotic, I am less satisfied when I don't receive one” (24% versus 14%). The researchers found that predictors of knowledge or attitudes demonstrated complex relationships between insurance status and sociodemographic variables. The study was published on July 14, 2015, in Pediatrics.

“While Medicaid parents showcase a higher rate of antibiotic misconception, the data indicate there is room to improve understanding of appropriate treatments for common illnesses regardless of insurance group,” concluded lead author Louise Elaine Vaz, MD, MPH, of OHSU, and colleagues. “These findings are important as parental attitudes may influence pediatricians to prescribe antibiotics when they may not be necessary, contributing to overuse of antibiotics.”

Antibiotic overuse causes bacterial resistance, an example of Darwinian evolution in action but with the pressure of natural selection on pathogens replaced by human pressure. Major drivers include self-medication, noncompliance, misinformation, and advertising, combined with ignorance, lack of education, and lack of access to healthcare. The problem is complicated by economic and social barriers to rational use of drugs, for example in hospitals that derive much of their revenue from medication sales.

Related Links:
Oregon Health & Science University
Tufts Medical Center