By Andrew M. Seaman
NEW YORK (Reuters Health) - Black children who saw doctors in Pennsylvania and New Jersey were less likely to be prescribed antibiotics for respiratory infections than their non-black peers, according to a new study.
Researchers, who looked at the health records of more than 200,000 children, found black kids were about 25 percent less likely to receive an antibiotic, compared to a predominantly white group of children.
"We thought that there would be variability, but were not sure that it would vary by patient race," Dr. Jeffrey Gerber, the study's lead author from The Children's Hospital of Philadelphia, said in an email to Reuters Health.
Given concerns about potential overuse of antibiotics, however, the findings do not necessarily mean black children are receiving worse care, they write in Pediatrics on Monday.
For the new study, the researchers used the health records of 222 doctors working at 25 offices in southeastern Pennsylvania and southern New Jersey to compare how kids of different races were diagnosed and treated in 2009.
Overall, they had information on about 1.3 million office visits made by about 209,000 kids, who were under 18 years old.
Of those visits, the researchers focused on about 363,000 that were for acute problems, such as ear, sinus and lung infections - instead of checkups and other routine care.
Gerber and his colleagues found that black children were taken to the doctors about once per year with an acute problem, compared to non-black children who went about twice per year.
And, after adjusting for several factors that may influence the results - such as the child's age, gender and insurance status - the researchers found black children were less likely than their white peers to receive an antibiotic prescription from the same doctor.
About 24 percent of black children were prescribed an antibiotic at their visits, compared to 29 percent of non-black children.
"What is particularly novel about this study is that these researchers found that these differences in prescribing occurred at the level of the individual doctor," Dr. Adam Hersh, who studied antibiotic use in children but was not involved in this study, told Reuters Health by email.
The researchers also found that black children were less likely to be diagnosed with conditions that would typically warrant an antibiotic prescription.
For example, about 2 percent of black kids were diagnosed with tonsillitis, compared with about 4 percent of non-black kids.
According to the researchers, there is no known reason why black children should have a lower incidence of tonsillitis, compared to children of other races.
ARE FEWER PRESCRIPTIONS A BAD THING?
Previous studies have found that antibiotics are overprescribed to children with respiratory infections, and it's possible the larger number of non-black children getting medication is a result of unnecessary prescriptions.
"It's more likely that this study is uncovering that some kids are actually over-treated. It also suggests that there may be differences in family preferences around using antibiotics for these infections," said Hersh, from the University of Utah in Salt Lake City.
But the researchers add that more studies are needed before they know whether fewer antibiotics lead black children to have worse outcomes.
They also add that the results may not apply to all areas of the country, because their study focused on only portions of two northeast states. Also, they can't rule out the possibility that other factors, such as the children's socioeconomic status, could influence the results.
"Parents should always ask questions about the management of their child's illness, including why an antibiotic is or is not indicated, especially because the majority of upper respiratory tract infections in children do not benefit from antibiotic use," Gerber said.
SOURCE: http://bit.ly/16EuM4V Pediatrics, online March 18, 2013.