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As public health officials struggle to contain antibiotic resistance, new research shows the task may be more difficult than some thought. A review of patient data found that as much as 30 percent of all antibiotics were prescribed unnecessarily in physician offices and clinics.

The study found that patients are often prescribed antibiotics for afflictions, such as the common cold, which can be treated differently. But prescribing rates are high because patients expect to receive antibiotics and physicians may believe patients hold such expectations, according to the study’s authors.

The research, which was published today in the Journal of the American Medical Association, comes amid ongoing concern about antibiotic resistance, which has been blamed for at least 2 million illnesses and 23,000 deaths annually, according to the US Centers for Disease Control and Prevention.


And the authors calculate that prescribing would have to drop by an estimated 15 percent in order to meet the goals in a White House plan to cut inappropriate antibiotic usage in half by 2020. The plan, which was released last year, also seeks to reduce inappropriate use in hospitals by 20 percent.

“The findings underscore how important it is that we address antibiotic use in all settings, because increased use leads to resistance and contributes to the public health threat,” said Dr. David Hyun, a study coauthor who is a senior officer at the Pew Charitable Trust antibiotics resistance project, which provided this infographic.


The study examined more than 184,000 patient visits to doctors and clinics in 2010 and 2011 and found that of the 506 prescriptions written for every 1,000 people, 353 were appropriate. In other words, nearly one of every three prescriptions for an antibiotic was unnecessary.

Looked at another way, roughly 47 million prescriptions for antibiotics should not be given to patients each year, according to Hyun. To be more specific, about 3 million prescriptions for bronchitis and 8 million prescriptions for viral upper respiratory problems — the common cold — are written annually.

The researchers also sliced the data for some ailments in order to examine differences in age groups and found 6 million prescriptions are written unnecessarily for sinus infections each year. Most are for adult patients, and the amount of prescribing for people between 20 and 64 years old should be cut in half.

The study did not examine antibiotic pricing and the effect on health care costs, but Hyun noted there are several studies of hospitals that restricted antibiotic use, demonstrating not only reduced resistance and improved patient outcomes but also lowered health care costs.

The pharmaceutical industry has been criticized for failing to invest sufficiently in new antibiotics. Last year, the Review on Antimicrobial Resistance, an effort commissioned by the UK government, proposed providing financial incentives to drug makers to develop new treatments.

The JAMA study also did not probe the extent to which pharmaceutical marketing may play a role in overprescribing, although Hyun indicated that this is “an area we need to explore. We’re still in the preliminary stages of understanding how industry can help or contribute to this issue.”

Some drug makers have also been criticized for improperly promoting antibiotics given to food-producing livestock. The US Food and Drug Administration issued guidelines for voluntarily removing language from labeling that indicates antibiotics can be used for weight gain. The effort begins later this year.

  • From the CDC

    Superbugs threaten hospital patients
    1 in 4 catheter- and surgery-related HAIs caused by six resistant bacteria in long-term hospitals

    Many of the most urgent and serious antibiotic-resistant bacteria threaten patients while they are being treated in healthcare facilities for other conditions, and may lead to sepsis or death. In acute care hospitals, 1 in 7 catheter- and surgery-related HAIs can be caused by any of the six antibiotic-resistant bacteria listed below. That number increases to 1 in 4 infections in long-term acute care hospitals, which treat patients who are generally very sick and stay, on average, more than 25 days.

    The six antibiotic-resistant threats examined are:

    Carbapenem-resistant Enterobacteriaceae (CRE)
    Methicillin-resistant Staphylococcus aureus (MRSA)
    ESBL-producing Enterobacteriaceae (extended-spectrum β-lactamases)
    Vancomycin-resistant Enterococcus (VRE)
    Multidrug-resistant Pseudomonas aeruginosa

    Multidrug-resistant C. difficile caused almost half a million infections in the United States in 2011 alone.

  • I also seem to recall that the act of writing the Rx allows the physician to charge for a visit, something that other approaches might not support. It makes the script a business driver, so to speak. Corrections cheerfully accepted.

    • This is not true. While prescription drug management is one of many factors that might be considered in coding, you generally can bill the same level of visit for something like bronchitis whether or not you prescribe an antibiotic. You can also do time-based billing if you spend an inordinate amount of time counseling on why the antibiotic is not needed.

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