Many Antibiotic Prescriptions Unnecessary, Study Says

Researchers found a large discrepancy between outpatient visits requiring antibiotics and the national prescribing rates.

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The Centers for Disease Control and Prevention has been working to reduce inappropriate antibiotic prescribing for a decade. But despite their efforts, researchers at Brigham and Women’s Hospital (BWH) found that there’s only been a slight improvement (well, reduction) in antibiotic prescribing for adults with acute bronchitis and sore throat. The findings were published online Thursday in JAMA Internal Medicine.

“We know that antibiotic prescribing, particularly to patients who are not likely to benefit from it, increases the prevalence of antibiotic-resistant bacteria, a growing concern both here in the United States and around the world,” said Dr. Jeffrey A. Linder, a physician and researcher in the Division of General Medicine and Primary Care at BWH and the senior author of the paper. “Our research shows that while only 10 percent of adults with sore throat have strep, the only common cause of sore throat requiring antibiotics, the national antibiotic prescribing rate for adults with sore throat has remained at 60 percent. For acute bronchitis, the right antibiotic prescribing rate should be near zero percent and the national antibiotic prescribing rate was 73 percent.”

Linder and his team measured changes in antibiotic prescriptions for adults with sore throat and acute bronchitis using national surveys of ambulatory care in the U.S. from 1996 through 2010. The data represented an estimated 39 million acute bronchitis and 92 million sore throat visits by adults to primary care clinics or emergency departments.

The researchers found that although visits for sore throats decreased in primary care visits from 7.5 percent in 1997 to 4.3 percent in 2010, the overall national antibiotic prescribing rate did not change. Physicians prescribed antibiotics at 60 percent of the visits. The researchers also noted an increase in the antibiotic prescribing rate in emergency rooms, from 69 percent to 73 percent, during the same 14-year period.

“In addition to contributing to the prevalence of antibiotic resistant bacteria, unnecessary use of antibiotics also adds financial cost to the health care system and causes adverse effects for those taking the medication,” said the study’s lead author Dr. Michael Barnett. “Most sore throats and cases of acute bronchitis should be treated with rest and fluids and do not require a visit to the doctor.”

In light of these findings, BWH says that research efforts are now underway to develop and implement interventions that will help to reduce inappropriate antibiotic prescribing for respiratory infections.