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Why do doctors give poor kids get antibiotics at a higher rate than rich ones?

Posted by Jesse Singal  January 20, 2011 03:58 PM

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There's an important editorial in today's Globe about antibiotics, kids, and asthma:

Researchers found that infants treated with antibiotics in their first six months were up to 52 percent more likely to develop asthma and allergies by age 6 than babies who did not get antibiotics. This result buttressed scientists’ suspicion that early use of the drugs can cause imbalances in the immune system and a poor allergic response.

This at the very least complicates the commonly held notion that poor kids get asthma because of environmental conditions. Even if that's true, it appears there's another factor at work.

The editorial also pointed out that poor kids were more likely to be treated with antibiotics than rich ones. This seems counterintuitive — one would expect poor kids to go to the doctor less, and, therefore, to be prescribed antibiotics less.

I asked Don MacGillis, the editorial page's resident health expert, for his thoughts:

One possible explanation for this is that when such children have ear aches, respiratory infections or other conditions for which their parents seek care, the infants are more likely to be treated by primary care clinicians under extreme time pressure. They know that by writing a prescription for an antibiotic they can quickly reassure the parent and ensure that, even if the illness is caused by a virus and not by bacteria that would respond to the antibiotic, the use of the drug will keep the viral infection from setting the stage for a bacterial infection.

The same thing probably applies to situations in which a parent, lacking timely access to a primary care physician, takes their sick kid to the emergency room instead. There as well, an antibiotic prescription is a likely outcome.

If all this is true, it's not a matter of quantity of care, but of quality of care. If you can get your kid to a specialist, they will be more likely to come up with the proper diagnosis, rather than simply prescribing antibiotics. Not so for overworked primary care physicians in poor neighborhoods who aren't in a position to refer their patients to specialists, or spend enough time with them.

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ABOUT THE ANGLE Online commentary and news analysis from the Boston Globe. The Angle is produced by Rob Anderson and Alan Wirzbicki. You can follow Rob on Twitter at @rcand.

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