Inappropriate Antibiotic Use

Study finds inappropriate antibiotic use highest in urgent care clinics. Executive from urgent care-focused medical records firm says study numbers miss some of the nuances.

Misuse of antibiotics has long plagued healthcare, but a study published this week zeroes in on urgent care clinics as having a particular issue with inappropriate prescription of the antimicrobial medicines.

The study, published as a research letter in JAMA Internal Medicine, found that urgent care centers saw the highest percentage among outpatient settings of prescriptions of antibiotics during visits for respiratory diseases in which they are not indicated, 45.7 percent. That compared with 24.6 percent in emergency departments, 17 percent in medical offices and 14.4 percent in retail clinics. Data came from the 2014 Truven Health MarketScan Commercial Claims and Encounters Database. Antibiotic-inappropriate indications included in the study were viral upper respiratory infection, bronchitis/bronchiolitis, asthma/allergy, influenza, nonsuppurative otitis media and viral pneumonia.

“Overall, the findings underscore the need for antibiotic stewardship not only in doctors’ offices and emergency clinics, but in urgent care and retail clinics as well,” said study co-author Dr. David Hyun, a senior officer for the Pew Charitable Trusts’ Antibiotic Resistance Project, in a phone interview. Antibiotic stewardship refers to promoting appropriate use of the drugs to improve patient outcomes and reduce the risk of antibiotic-resistant bacteria.

Total inappropriate use of antibiotics may approach 50 percent of all prescriptions for the drugs in the outpatient setting, with at least 30 percent of courses prescribed being unnecessary, according to the Centers for Disease Control and Prevention, which sponsored the study. Indeed, resistance to antibiotics represents one of the most urgent threats to public health, and their overuse is a major cause of increases in drug-resistant bacteria.

Indeed, the interest is in looking at antibiotic prescribing across the outpatient practice spectrum and finding opportunities to improve antibiotic use throughout, said co-author Dr. Katherine Fleming-Dutra, deputy director of the CDC’s Office of Antibiotic Stewardship.

Hyun and Fleming-Dutra noted that the study didn’t go into potential drivers of the disparity in inappropriate antibiotic prescribing. It is known from medical literature that diagnostic uncertainty – in which the physician is uncertain whether an ailment is antibiotic-appropriate or not – is a factor, as is demand from patients, they said. “Patients want or demand antibiotics, so doctors are more likely to prescribe them when they think that’s what the patient expects,” Fleming-Dutra said, adding that this happens in all outpatient settings.

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