Infectious Diseases / Primary Care

30% of Outpatient Antibiotics Unnecessary

Though inappropriate antibiotic use is certainly well documented, such cases are typically considered to be improper administration techniques or therapy durations. What is less notorious but perhaps more concerning, however, is the altogether unwarranted use of antibiotics that provides furthers the resistance adaptations of bacterial species. Such mistakes are not only non-beneficial in the short-term or potentially disastrous in the long-term but, according to new reports, are exceedingly prevalent. The CDC now estimates that 30% of outpatient antibiotic use is entirely unnecessary.

With antibiotic resistance increasingly becoming one of the world’s most pressing health threats, such a pervasive mistake is incredibly worrisome. A medical epidemiologist at the CDC’s Office of Antibiotic Stewardship, Katherine Fleming-Dutra, MD, estimates that nearly “2 million patients a year” already contract infections resistant to antibiotics, and that per year “approximately 23,000 people die of these infections.” Flemming-Dutra, as the lead author of the CDC study, asserts that stemming the tide of bacterial antibiotic resistance, then, necessitates “eliminating unnecessary antibiotic use.”

This alarming study drew data from the 2010-2011 National Ambulatory Medical Care Survey as well as the National Hospital Ambulatory Medical Care Survey. Using national guidelines but also accounting for regional variation in prescription protocol, the researchers compiled data on antibiotic prescriptions to estimate the annual antibiotic prescription rate per 1,000 patients.

The data was composed of 184,032 sampled visits, 12.6% of which involved an antibiotic prescription. The dataset only considered patients once they were discharged, so it did not take into account hospitalized patients. Of the diseases meriting prescription, sinus and middle ear infections were the most common, while pharyngitis was also prevalent. Among all antibiotic prescriptions types, acute respiratory infections as a class accounted for nearly 40% of all antibiotic prescriptions annually at 221 prescriptions per 1,000 patients. Unfortunately, only 111, or just over 50% of these prescriptions, were estimated to be appropriate or necessary. Among the entire patient population surveyed, 29.82% of the 506 antibiotic prescriptions per 1,000 patients were deemed inappropriate and unnecessary.

In attempting to pinpoint causes for the problems of over-prescription, Fleming-Dutra named parental expectation of antibiotics as well as a flawed belief among patients that antibiotics can affect viral diseases. In addition to changing these misconceptions, the heightened emphasis of antibiotic stewardship in ambulatory care could help to mitigate unnecessary prescription, Fleming-Dutra claims.

The current practices, if left unchanged, could fast-track the evolution of so-called super-bugs and increased anti-microbial resistance can endanger thousands of lives. Preventing such a situation, then, is predicated upon appropriate, effective and, above all, necessary antibiotic prescription practices.

All quotes and study data obtained from:

Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011 JAMA. 2016;315(17):1864-1873.