Nearly Half of Outpatient Antibiotics Prescribed Without Infection Diagnosis

A new multi-institutional study presented at ID Week 2018, investigators have found that too many antibiotics prescribed at outpatient clinics are given without an infection-related diagnosis, with some patients receiving antibiotics without an in-patient visit.

Changing antibiotic prescribing practices has been a key objective of antibiotic stewardship efforts to stem the problem of antibiotic resistance, a problem leading to more than 2 million illnesses and 23,000 deaths in the United States each year. A 2016 study by the Centers for Disease Control and Prevention (CDC) found that at least 30% of antibiotics prescribed in the United States are unnecessary. More recent research on antibiotic prescribing in the growing number of urgent care centers in the country has found that more than 45% of patients visiting these centers for respiratory infections are receiving unnecessary antibiotic prescriptions, nearly twice the rate of US emergency departments. In addition, a recent study on adverse drug events from antibiotics in children has also shed light on the need for reducing antibiotic overprescribing.

On October 5, 2018, at ID Week, investigators from the Northwestern University Feinberg School of Medicine in Chicago, the University of Michigan Medical School in Ann Arbor, and Brigham and Women's Hospital/Harvard Medical School in Boston, presented the results from their new study examining outpatient antibiotic prescriptions. To measure the prevalence of non-visit-based and non-infection-related oral antibiotic prescribing, the research team examined 509,534 antibiotic prescriptions made to 279,169 patients by 2,413 clinicians in 514 clinics between November 2015 and October 2017. The investigators found that clinicians prescribed 46% of antibiotics without an infection-related diagnosis, including 29% non-infection-related prescriptions and 17% associated with no diagnosis. In addition, 20% of the antibiotics that clinicians prescribed were done without an in-person visit. Penicillins and macrolides made up more than half of all antibiotics prescribed.

“We looked at all outpatient antibiotic prescribing and results suggest misuse of these drugs is a huge problem, no matter the symptom,” said the study’s lead author Jeffrey A. Linder, MD, MPH, in a recent statement. “We found that nearly half the time, clinicians have either a bad reason for prescribing antibiotics or don’t provide a reason at all. When you consider about 80% of antibiotics are prescribed on an outpatient basis, that’s a concern.”

The study was funded by the Agency for Healthcare Research and Quality (AHRQ) and gives investigators a new look at inappropriate antibiotic prescribing, including for infections caused by viruses.

“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,” Dr. Linder said. “At busy clinics, sadly the most efficient thing to do is just call in an antibiotic prescription. 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.”