Alarming Amount of Antibiotic Prescriptions Are Inappropriate

About 30% of all outpatient oral antibiotic prescriptions written in the United States are inappropriate, a new CDC study suggests.

CDC researchers used data from the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to determine the rates of outpatient oral antibiotic prescribing by patient age and diagnosis, as well as the estimated amount of antibiotic use that could be considered inappropriate.

Of the 184,032 outpatient visits included in the data, 12.6% resulted in an antibiotic prescription. The researchers estimated that 353 of the 506 antibiotic prescriptions written annually per 1000 population were appropriate.

Broken down further, the data revealed that sinusitis diagnoses resulted in the most antibiotic prescriptions per 1000 population (56), followed by ear infections (47), and pharyngitis (43).

“Half of antibiotic prescriptions for acute respiratory conditions may have been unnecessary, representing 34 million antibiotic prescriptions annually,” the researchers wrote. “Collectively across all conditions, an estimated 30% of outpatient oral antibiotic prescriptions may have been inappropriate.”

Last fall, the President signed an Executive Order on “detecting, preventing, and controlling antibiotic-resistant microbes” as part of the White House’s 5-year National Action Plan for Combating Antibiotic-Resistant Bacteria, which aims to reduce inappropriate antibiotic use in outpatient settings by 50% by 2020. Based on the current study results, a 15% reduction in overall antibiotic use would be necessary in order to meet that goal, the researchers noted.

Because antibiotic overprescribing contributes to drug resistance, curbing the practice is a major public health care priority. Failure to do so could have grim consequences, as the CDC already estimates that 2 million individuals are infected with antibiotic-resistant bacteria each year in the United States, and 23,000 of them die from these infections annually.

In one of the more notorious examples, UCLA Health indicated that 179 patients might have been infected with “superbug” carbapenem-resistant Enterobacteriaceae at the Ronald Reagan UCLA Medical Center during “complex endoscopic procedures that took place between October 2014 and January 2015.”

“Health professionals generally know when antibiotics are and are not needed,” lead study author Katherine Fleming-Dutra, MD, a medical epidemiologist with the CDC’s Office of Antibiotic Stewardship, explained to Pharmacy Times. “Often, clinicians are worried about patient satisfaction. They think that a patient wants antibiotics…sometimes leading them to prescribe when they shouldn’t.”

Pharmacists can help prevent this by providing patients with information about the potential consequences of unnecessary antibiotic use.

“Pharmacists are the last health professional to see a patient when an antibiotic is prescribed,” Dr. Fleming-Dutra said. “When dispensing antibiotics, pharmacists can educate patients about properly taking antibiotics and about potential harms from antibiotics such as allergies, adverse events, and antibiotic resistance.”

Beyond treating infections, other studies have found that as many as 1 in 10 health care providers prescribe antibiotics for almost every patient they see with a cold or bronchitis, despite the fact that antibiotics aren’t effective against viral infections.

“It is important for all health professionals in all regions seeing patients of all ages to only prescribe antibiotics when they are needed, and if needed, select the right antibiotic at the right dose for the right duration,” Dr. Fleming-Dutra advised.

The current study results appeared in the May 3, 2016, edition of JAMA.