Study Finds Almost Half of Antibiotic Prescriptions Written Without a Diagnosis

Many bacterial infections have become easily treatable with the discovery and widespread availability of antibiotics.

But though treatment with antibiotics is sometimes necessary, overprescribing the bacteria-killing drugs can be dangerous.

The results of a study of more than 500,000 prescriptions and 514 outpatient clinics found that nearly half of all antibiotics prescribed are prescribed without the diagnosis of an infection, with 1 in 5 prescriptions written without an in-person visit. The study was presented at ID Week 2018 in San Francisco, California.

Previous studies have shown overprescribing in relation to certain symptoms, such as a cough or sore throat, without a diagnosis.

The study's researchers noted that antibiotics should not be prescribed in these cases, as these symptoms are often caused by viruses.

Antibiotics have no effect on viral infections, as they only kill bacteria, according to the study.

"We looked at all outpatient antibiotic prescribing, and results suggest misuse of these drugs is a huge problem, no matter the symptom,” said lead author Jeffrey A. Linder, MD, MPH.

“We found that nearly half the time, clinicians have either a bad reason for prescribing antibiotics, or don't provide a reason at all," he said. "When you consider about 80% of antibiotics are prescribed on an outpatient basis, that's a concern."

The study analyzed 509,534 outpatient antibiotic prescriptions given to 279,196 patients between November 2015 and October 2017.

The researchers gathered these data from 2413 clinicians, including physicians, attending physicians, nurse practitioners, and physician assistants in specialty fields, at 514 health care clinics, according to the study.

Researchers were able to determine that 46% of antibiotics were prescribed without diagnosing an infection, while 29% were given with the diagnosis of an unrelated issue, such as high blood pressure or an annual visit.

They also determined that 17% of prescriptions were written without a diagnosis indicated, according to the study.

Although some of the results could be attributed to poor diagnosis coding, researchers suggest that a large portion of them are the result of inappropriate or vague prescribing.

Researchers also found that 20% of antibiotics were not prescribed during an in-person visit, with 10% being prescribed over the phone. Another 4% were prescribed through an electronic health record system that did not allow clinicians to gather information about symptoms or conduct tests. Additionally 4% were refilled, and 1% were prescribed on an online portal. This is appropriate for certain cases, such as women suffering from recurrent urinary tract infections or teenagers taking antibiotics to treat acne. To address the issue of overprescribing, while still meeting actual needs, researchers plan on looking further into these prescriptions in the next phase of their research.

"Despite 40 years of randomized controlled trials showing antibiotics don't help for most coughs and sinus infections, many people are convinced they will not get better without an antibiotic and specifically call the doctor requesting one," Linder said.

"At busy clinics, sadly the most efficient thing to do is just call in an antibiotic prescription," he said. "We need to dig into the data more, but we believe there is a lot of antibiotic prescribing for colds, the flu and non-specific symptoms such as just not feeling well, none of which are helped by antibiotics."

Reference

Outpatient antibiotic overprescribing is rampant [news release]. San Francisco, CA: October 5, 2018; Infectious Diseases Society of America. eurekalert.org/pub_releases/2018-10/idso-oao100318.php. Accessed October 5, 2018.