Antibiotics Still Overused for Viral Infections

Article

As many as 1 in 10 health care providers prescribe antibiotics for almost every patient they see with a cold or bronchitis, despite the fact that antibiotics are not effective against these viral infections.

As many as 1 in 10 health care providers prescribe antibiotics for almost every patient they see with a cold or bronchitis, despite the fact that antibiotics are not effective against these viral infections.

Recently, researchers reviewed antibiotic prescribing patterns at 130 Veterans Affairs Medical Centers between 2005 and 2012, specifically considering more than 1 million patient visits for acute respiratory infections (ARIs).

Antibiotics can treat bacterial infections such as strep throat, but they do not treat infections caused by viruses such as ARIs. As a result, receiving an antibiotic for an ARI promotes drug resistance.

Nevertheless, 68.4% of the examined patient encounters for ARIs ended with an antibiotic prescription, and 43.3% of the time, the prescribed antibiotics were broad-spectrum macrolides.

Furthermore, the rate of antibiotic prescriptions increased 2% during the study period, from 67.5% in 2005 to 69.2% in 2012.

The researchers also found significant variation in antibiotic prescribing across health care providers, as they determined 10% of providers wrote an antibiotic prescription in at least 95% of ARI-related visits, while another 10% wrote such a prescription in only 40% or fewer visits.

These numbers “suggest that providers have a strong tendency to choose the same treatment regardless of patient or clinic characteristics, indicating that individual provider preference or ‘style’ heavily influences the antibiotic decision,” the study authors wrote.

Because antibiotic overprescribing contributes to drug resistance, curbing this practice is a major public health priority in the United States.

Last fall, President Barack Obama signed an Executive Order on “detecting, preventing, and controlling antibiotic-resistant microbes” as part of the 5-year National Action Plan for Combating Antibiotic-Resistant Bacteria.

At the prescriber level, Ashley Marx, PharmD, BCPS, previously explained that health systems in the United States are “taking stock of opportunities to adopt and enhance” these antibiotic and antimicrobial stewardship efforts.

An annual survey conducted by the US Centers for Medicaid and Medicare Services aims to measure antibiotic stewardship in US acute-care settings. It “requires prescribers to specify the indication, dose, and duration of antibiotic orders, and provides a mechanism for an ‘antibiotic time-out’ whereby all providers can review the appropriateness of antimicrobial therapy after 48 hours of therapy.”

Such efforts could help health systems identify and correct patterns of antibiotic overprescribing, the current study authors concluded.

“As our understanding of the relationship between providers, patients, stings, and treatment decisions improves, so will our ability to target future information and stewardship efforts,” they wrote.

The study was published in the July 21, 2015, issue of the Annals of Internal Medicine.

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