One-third of antibiotic prescriptions may be inappropriate, per study by JAMA and CDC

Research findings support the need to establish a goal of increased antibiotic stewardship among physicians.
Research findings support the need to establish a goal of increased antibiotic stewardship among physicians.

Nearly 30% of outpatient oral antibiotics prescribed between 2010 and 2011 may have been inappropriate, according to research published in JAMA.

Katherine E. Fleming-Dutra, MD, of the CDC, and colleagues used data gathered from the 2010-2011 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey to estimate rates of prescription for outpatient oral antibiotics; data were analyzed by age and diagnosis.

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“Half of antibiotic prescriptions for acute respiratory conditions may have been unnecessary, representing 34 million antibiotic prescriptions annually,” Dr Fleming-Dutra noted. Across nearly 185,000 sampled visits, the researchers found that 12.6% of the visits resulted in an antibiotic prescription. Sinusitis was associated with the most prescriptions, with 56 prescriptions per 1000 population, followed by suppurative otitis media (47 prescriptions) and pharyngitis (43 prescriptions). In total, 221 antibiotic prescriptions per 1000 population were written annually for acute respiratory conditions; only 111 of these prescriptions were deemed appropriate. Among all ages and conditions, researchers estimated that 506 antibiotic prescriptions had been written per 1000 population, of which only 353 were appropriate.

“Despite the likely conservative estimate of inappropriate outpatient antibiotic use … these findings offer an important and useful starting point to understand prescribing practices in the ambulatory care setting,” wrote Prantina D. Tamma, MD, MHS, and Sara E. Cosgrove, MD, MS, of the Johns Hopkins University School of Medicine, in an accompanying JAMA editorial.

Drs Tamma and Cosgrove noted two strategies that would need to be implemented to improve antibiotic prescribing practices: clinician behavior should be modified to “alleviate concerns related to diagnostic uncertainty, alienating patients, and not conforming to peer practices,” and patients and families should be educated as to the role that antibiotics play in medical care. 

References

  1. 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; doi: 10.1001/jama.2016.4151
  2. Cosgrove SE, Tamma PD. Addressing the appropriateness of outpatient antibiotic prescribing in the United States. An important first step. JAMA. 2016;315(17):1839-1841; doi: 10.1001/jama.2016.4286
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