Study: Antibiotic Prescription Rates for Black, Hispanic, Older Patients Are Alarmingly High

Almost three-quarters of antibiotics prescriptions to individuals aged 65 years or older were inappropriate, according to the investigators in a study that analyzed more than 7 billion visits to emergency departments, hospital clinics, and physician offices in the United States during a 7-year period.

Additionally, two-thirds of antibiotics prescribed to Black individuals were also inappropriate, the study results showed.

“Our results suggest that Black and Hispanic/LatinX patients may not be properly treated and are receiving antibiotic prescriptions even when not indicated,” Eric Young, PhD, PharmD, of the University of Texas Health Science Center San Antonio, said in a statement.

“We know that physicians typically send patients home with antibiotics if they suspect their symptoms may lead to an infection,” he said. “This practice becomes more common when patients are unlikely to return for a follow-up visit, which more frequently happens in minority populations.”

The study was conducted by the University of Texas Health Science Center in San Antonio, Texas, and is being presented at the European Congress of Clinical Microbiology & Infectious Diseases in Lisbon, Portugal, which takes place April 23 to April 26, 2022.

Of these visits, approximately 11%, or 8 million, resulted in antibiotic prescriptions, foremost commonly for illnesses that are not caused by a bacterial infection, such as bronchitis, non-bacterial skin conditions, and viral respiratory-tract infections.

The findings raise questions about the effectiveness of efforts to curb inappropriate prescribing and highlight the need to address inappropriate prescribing in primary care, investigators said.

There have been few studies that explored how antibiotic prescribing is influenced by different patient characteristics, such as age, ethnicity, race, and sex. Investigators aimed to examine disparities in rates of inappropriate and overall antibiotic prescribing by patient demographics in outpatient physician offices across the United States.

The findings were based on prescribing data from the United States CDC National Ambulatory Medical Care Survey that covered more than 5.7 million individuals across the nation.

Investigators defined antibiotic use as at least 1 oral antibiotic prescription ordered during a physician visit. Investigators used official diagnostic codes to identify whether each antibiotic prescription was appropriate, inappropriate, or possibly appropriate.

Antibiotic prescribing was defined as visits that included an antibiotic per 1000 total patient visits.

Using this information, the investigators evaluated inappropriate and overall use by age, ethnicity, race, and sex.

They found that overall, antibiotic prescribing rates were highest among Black and Hispanic/LatinX individuals, with 122 and 139 prescriptions per 1000 visits, respectively, and in individuals younger than aged 18 years sand females, with 114 and 170 per 1000 visits, respectively.

Upon further examination, they also found that 64% of antibiotic prescriptions written to Black individuals were inappropriate, as well as 58% to Hispanic/LatinX individuals.

Additionally, 74% of prescriptions dispensed to individuals who were aged 65 years and older and 58% to males were also deemed inappropriate.

“In older adults, inappropriate prescribing in primary care is associated with a wide range of adverse outcomes, including emergency hospital attendances and admissions, adverse drug events, and poorer quality of life. Our results underscore that strategies to reduce inappropriate prescribing must be tailored for outpatient settings,” Young said.

The study is observational and only shows a correlation, and no official conclusions can be drawn about cause and effect, investigators said.

Investigators could rule out the possibility of other facts that could have affected the outcomes found.

Reference

Alarmingly high rates of inappropriate antibiotic prescribing to older and Black patients, finds US study. EurekAlert. News release. April 20, 2022. Accessed April 21, 2022. https://www.eurekalert.org/news-releases/950149