In a busy medical setting such as an urgent care or emergency department, physicians may be tempted to prescribe antibiotics to patients who request them, even if they are unlikely to be helpful. However, a major study by researchers at Intermountain Health and Stanford University found that overprescribing and inappropriately prescribing antibiotics leads to antibiotic resistance and significant patient harm.
The study, published in the Journal of Internal Medicine, examined 51 million patient encounters over 15 years, focusing on upper respiratory infections, where antibiotics were known to be overprescribed half of the time. The researchers found that some of the most dangerous antibiotics were rarely indicated but commonly used, leading to one in 300 patients experiencing severe side effects, which required a follow-up doctor’s visit or even hospitalization.
Using data from Medicare Advantage and commercial insurance patients across all 50 states between December 2002 and December 2017, the researchers identified 50.9 million claims for upper respiratory infections, which represented 23 million unique patients. They discovered that 62.4% of these patients filled a prescription for an antibiotic, with 26% having a follow-up outpatient visit within 14 days.
Adverse events increased by 30% for patients receiving antibiotics, with as many as one in 300 prescriptions resulting in severe side effects, depending on the specific antibiotic. Dr. Harris Carmichael, the principal investigator of the study, said that inappropriately prescribing antibiotics causes widespread harm and emphasized the need for antibiotic stewardship programs.
The study also found that the antibiotic Cefdinir was the fourth most prescribed for upper respiratory infections, despite it rarely being recommended by guidelines. This drug had the second-highest chance of leading to an adverse event. Dr. Carmichael added that the chance of adverse events is likely higher than the study suggests, as the results only capture follow-up visits where the side effect was coded for insurance purposes.
Implementing antibiotic stewardship programs, where physicians only prescribe antibiotics when necessary and ensure they are the right ones for the condition, is crucial. When Intermountain implemented their own stewardship program, which included explaining to patients why they weren’t being prescribed an antibiotic if they asked for it, the health system reduced its overall prescribing rates by more than 15%. Dr. Carmichael stated that patients are not upset when they don’t receive antibiotics, as long as the reasons are clearly explained to them.
Key Takeaways in a Nutshell – Health Newstrack
- Overprescribing and inappropriately prescribing antibiotics leads to antibiotic resistance and significant patient harm.
- A study found that some dangerous antibiotics were commonly used, with one in 300 patients experiencing severe side effects.
- Antibiotic stewardship programs are essential to ensure that physicians only prescribe antibiotics when necessary and choose the right ones for the specific condition.
- Intermountain Health reduced their antibiotic prescribing rates by over 15% after implementing an antibiotic stewardship program.
- Patients are generally not upset when they don’t receive antibiotics, as long as the reasons are clearly explained to them.