Up to two-fifths of antibiotic prescriptions in the US could be inappropriate

December 11, 2019

As much as two fifths (43%) of antibiotic prescriptions in the United States could be inappropriate, warn researchers in a study published by The BMJ today.

Such a high degree of potentially unnecessary prescribing has important implications for antibiotic stewardship - efforts to reduce antibiotic use in response to the growing threat of antimicrobial resistance.

Inappropriate antibiotic prescribing is a major public health problem. Studies examining the appropriateness of antibiotic prescribing rely on a "documented indication" in patients' medical records. But these are not always required, leading to missing data and underestimates of antibiotic use.

So a team of researchers based in Oregon set out to estimate how often antibiotics are prescribed without a documented indication in non-hospital (ambulatory) care settings in the United States, and what factors are associated with lack of documentation.

Using data from the National Ambulatory Medical Care Survey (NAMCS), they analysed 28,332 visits (representing over 990 million visits across the United States) to office-based healthcare providers in 2015.

Of these visits, around 130 million (13%) involved an antibiotic prescription and were included in the study.

The researchers then used official diagnostic codes to identify whether each antibiotic prescription was accompanied by appropriate, inappropriate, or no documented indication.

According to their criteria, 57% (around 74 million) antibiotic prescriptions were deemed appropriate, while 25% (around 32 million) were considered inappropriate, and 18% (around 24 million) lacked either an appropriate or inappropriate documented indication.

This means that as much as 43% of prescriptions in this analysis could be potentially inappropriate, say the researchers.

When they looked at the data in more detail, they found that 20% of adults aged 18-64 and 22% of adults aged 65 years and older received antibiotics without a documented indication compared with 8% of patients under 18 years.

Patients who spent more time with a physician were more likely to receive an antibiotic without indication (15% for those with shorter visits vs 21% with longer visits). Patients with chronic conditions were also more likely to receive an antibiotic without indication (22% for those with a chronic condition vs 14% for those without).

Primary care providers had a significantly lower percentage of antibiotic prescriptions without an indication documented (12%) compared with other specialists who commonly prescribe antibiotics (24%) as well as those in all other specialties (29%).

There were no differences in prescribing without indication by type of antibiotic, ethnicity, day of the week, or across seasons.

This is an observational study, so can't establish cause, and the researchers point to some limitations, such as relying on only the first five diagnostic codes documented in the health record, and not assessing prescriptions provided as part of virtual or telephone consultations.

Nevertheless, the results are based on nationally representative survey data, so are highly generalisable to the US population.

As such, the researchers say this study "demonstrates that indications for antibiotic prescribing are not always adequately documented and this can lead to underestimates of the true burden of unnecessary antibiotic use in ambulatory care settings."

They add: "Our study identified a wide range of factors associated with antibiotic prescribing without a documented indication, which may be useful in directing initiatives aimed at supporting better documentation."

A comprehensive coding system is central to effective antibiotic stewardship, says Professor Alastair Hay at the University of Bristol, in a linked editorial. This should involve ensuring that a diagnostic code is recorded every time an antibiotic is prescribed, and that all infections are coded (not just those for which an antibiotic is being prescribed).

Along with other strategies, such as better infection control, vaccination, and improved diagnostic precision, this information could help clinicians reflect on and refine their prescribing behaviour, he concludes.
Peer-reviewed? Yes (research); No (linked editorial)

Evidence type: Observational; Opinion

Subjects: Antibiotic prescriptions


Related Antibiotics Articles from Brightsurf:

Insights in the search for new antibiotics
A collaborative research team from the University of Oklahoma, the Memorial Sloan Kettering Cancer Center and Merck & Co. published an opinion article in the journal, Nature Chemical Biology, that addresses the gap in the discovery of new antibiotics.

New tricks for old antibiotics
The study published in the journal Immunity reveals that tetracyclines (broad spectre antibiotics), by partially inhibiting cell mitochondria activity, induce a compensatory response on the organism that decreases tissue damage caused during infection.

Benefits, risks seen with antibiotics-first for appendicitis
Antibiotics are a good choice for some patients with appendicitis but not all, according to study results published today in the New England Journal of Medicine.

How antibiotics interact
Understanding bottleneck effects in the translation of bacterial proteins can lead to a more effective combination of antibiotics / study in 'Nature Communications'

Are antivitamins the new antibiotics?
Antibiotics are among the most important discoveries of modern medicine and have saved millions of lives since the discovery of penicillin almost 100 years ago.

Hygiene reduces the need for antibiotics by up to 30%
A new paper published in the American Journal of Infection Control (AJIC), finds improved everyday hygiene practices, such as hand-washing, reduces the risk of common infections by up to 50%, reducing the need for antibiotics, by up to 30%.

Antibiotics: City dwellers and children take the most
City dwellers take more antibiotics than people in rural areas; children and the elderly use them more often than middle-aged people; the use of antibiotics decreases as education increases, but only in rich countries: These are three of the more striking trends identified by researchers of the NRW Forschungskolleg ''One Health and Urban Transformation'' at the University of Bonn.

Metals could be the link to new antibiotics
Compounds containing metals could hold the key to the next generation of antibiotics to combat the growing threat of global antibiotic resistance.

Antibiotics from the sea
The team led by Prof. Christian Jogler of Friedrich Schiller University, Jena, has succeeded in cultivating several dozen marine bacteria in the laboratory -- bacteria that had previously been paid little attention.

Antibiotics not necessary for most toothaches, according to new ADA guideline
The American Dental Association (ADA) announced today a new guideline indicating that in most cases, antibiotics are not recommended for toothaches.

Read More: Antibiotics News and Antibiotics Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.