The government has a new strategy for reducing the unnecessary use of antibiotics: Persuade parents to stop pestering pediatricians to write prescriptions for runny noses.
Health officials have already hammered on doctors to quit dispensing antibiotics in situations where they are practically guaranteed not to work, such as common colds. A straight-to-Mom-and-Dad campaign is next.
The effort, announced Wednesday, is built around public service ads featuring pictures of cranky-looking kids and the headline: "Snort. Sniffle. Sneeze. No antibiotics please."
"Doctors, like everybody else, like to please their patients," said Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention. "If a patient comes in with strong expectations, it is tempting — and takes less time — to write the prescription for antibiotics."
And that, virtually everyone agrees, is not a good thing. Overuse of antibiotics has led to the evolution of germs that are resistant to standard medicines, such as penicillin. Anyone who has recently taken antibiotics has an increased risk of coming down with a resistant infection.
Earlier campaigns, aimed at health professionals, already seem to have paid off. Various studies suggest that use of antibiotic pills has fallen about 25 percent in the past decade, and the decline has been even greater in pediatric medicine.
Still, officials say, there is much room for improvement. The CDC's Dr. Richard Besser said a study in 1995 found that over 40 percent of outpatient antibiotic prescriptions were for viral infections.
That violates a basic rule of medicine: Antibiotics kill bacteria. They are powerless against viruses, which cause the common cold, among other things. Most of these common viruses cannot be cured with any drug. Only time will make them go away.
Nevertheless, many people expect, or demand, an antibiotic if they feel under the weather, even if their illness is clearly viral. Doctors often oblige, because it is easier than arguing.
"You can't imagine on a daily basis the pressure on a physician to write that antibiotic," said Dr. Michael Fleming of Shreveport, La., president-elect of the American Academy of Family Physicians.
A recent CDC survey found that half of adults believe that if they are sick enough to see the doctor for a cold, they deserve an antibiotic. Even more are unaware there is any risk to taking antibiotics.
The new campaign will involve print, TV and radio ads and cost $1.6 million. It was announced at a meeting in Chicago of the American Society for Microbiology.
Besser said a main focus will be to convince parents that they do not need antibiotics for their children's colds. Instead, they should settle for doctors' advice on treatments that will relieve symptoms while the infections run their course.
Otitis media — middle-ear infections — are another area where antibiotics are misused. About half of these infections are caused by viruses and so will not be helped by antibiotics.
Dr. Margaret Rennels of the University of Maryland, chair of the American Academy of Pediatrics' infectious-disease committee, said doctors are becoming more willing to suggest "watchful waiting" for these infections.
She noted that some fluid behind the middle ear is common in children's colds and will not be relieved by an antibiotic. Doctors can often tell just by looking whether the infection is bacterial and will respond to antibiotics.
"Only a child who has purulent pus behind the middle ear with a red, bulging ear drum should be prescribed an antibiotic," she said.