1 in 3 Antibiotics Prescribed in U.S. Are Unnecessary

According to a recent study by the Centers for Disease Control and Preparedness (CDC) and the Pew Charitable Trust, nearly a third of antibiotics prescribed in doctors’ offices, emergency rooms, and hospital-based clinics in the United States are unnecessary.

The CDC study found that approximately 47 million unnecessary prescriptions are provided to patients every year across the country, for both children and adults. A large percentage of these were provided for conditions which do not even respond well to antibiotics, such as bronchitis, flu, sore throats, and additional viral illnesses.

“We’ve all been hearing, ‘This is a problem, this is problem,’ and we all understood the general concept that there is a lot of antibiotic use,” said David Hyun, a senior officer with Pew’s antibiotic resistance project and one of the authors of the report.

This is an issue that has been on CTeL’s agenda since 2013. Because of CTeL’s concern about the practice of safe telemedicine and the potential for antibiotic overprescribing, particularly with the proliferation of virtual health care models, CTeL’s board of directors adopted CTeL’s Safe Telemedicine Principles.

The CTeL Telemedicine Principles contain two key components. First, the virtual encounter must be equivalent to what would occur during an in person encounter. This mirrors most, if not all state laws and policies. Second, if a diagnostic test (e.g. strep, urine) would (or, perhaps better stated reflecting this article, should) be used during an in person encounter to confirm the diagnosis, then a diagnostic test should be incorporated into a virtual telehealth encounter.

Without a confirming diagnostic test, common sense would cause one to question whether the encounter is equivalent to an in person encounter, and therefore compliant with state law.

According to the CDC, practice guidelines of key medical societies require a diagnostic test to confirm the diagnosis. Looking at the patient’s throat in the web camera or having the patient feel their neck and report back to the doctor on a phone call is not a diagnostic test.

Experts continue to warn against the negligent use of antibiotics on future health care.

“Antibiotics are life-saving drugs, and if we continue down the road of inappropriate use we’ll lose the most powerful tool we have to fight life-threatening infections,” said CDC Director Tom Frieden. “Losing these antibiotics would undermine our ability to treat patients with deadly infections [and] cancer, provide organ transplants and save victims of burns and trauma.”

CDC and PEW published several important key findings:

  • About 13 percent of all outpatient visits in the United States — about 154 million visits annually — result in an antibiotic prescription.
  • More than four in 10 (44 percent) of antibiotic prescriptions are written to treat patients with acute respiratory conditions, such as sinus infections, middle ear infections, sore throats, colds, bronchitis, asthma, allergies, flu, and pneumonia.
  • Half of these prescriptions are unnecessary because many are for treating viral illnesses, unresponsive to antibiotic drugs.

But why do physicians overprescribe antibiotics? Oftentimes, patient pressures.

“Clinicians are concerned about patient satisfaction and the patient demand for antibiotics,” she said. But the majority of individuals trust their doctors are making the correct medical decision for them, better communication from doctors about the dangers of antibiotic overuse can lead to more appropriate prescribing, she said.

A frightening component of this study is the underreporting of the numbers, as the findings do not take into account prescriptions made via telehealth (over the phone), urgent care clinics, retail pharmacists, dentist visits, and prescriptions from nurse practitioners and physician assistants.

The overuse of antibiotics has led to the frightening rise of drug-resistant superbugs in recent years. The CDC has warned that “nightmare bacteria” are increasingly resistant to even the strongest antibiotics, posing a growing threat to hospitals and nursing homes nationwide.

In 2015, the White House announced an aggressive plan to manage antibiotic-resistant bacteria. These resistant bugs have caused an estimated 2 million illnesses and 23,000 deaths in the U.S. alone each year. In order to achieve the goal of reducing inappropriate antibiotic use in outpatients settings in half by 2020, outpatient antibiotic use needs to be cut by 15 percent overall.

For more information on the CDC and PEW report click here.

To read the White House Antibiotic Resistance Plan click here. 

To read the complete Wall Street Journal article on this plan click here (subscription may be necessary). 

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