21 Sep New Study Shows Many Patients Not Receiving Right Type of Antibiotics
Guest authors: Adam Hersh, MD, PhD and Jeffrey Linder, MD, MPH, FACP
Prescribing the right antibiotic for a patient’s infection is critical both to the wellbeing of the patient and to slowing the spread of antibiotic resistance. Yet, many individuals diagnosed with common bacterial infections in doctors’ offices, emergency rooms and hospital-based clinics in the United States are not receiving the most appropriate antibiotic for their condition.
Together with experts from the Centers for Disease Control and Prevention (CDC), The Pew Charitable Trusts, and other antibiotic use specialists, we published new research this week in the Journal of the American Medical Association Internal Medicine (JAMA IM) and in a corresponding report from The Pew Charitable Trusts, showing that only half (52 percent) of patients treated with antibiotics for sinus infections, ear infections and pharyngitis (sore throat) are receiving recommended first-line drugs. This is especially important because these three conditions alone account for 44 million antibiotic prescriptions annually, nearly one third of all antibiotics issued in outpatient facilities across the country every year.
Based on established medical guidelines and best practices, we found that approximately 80 percent of patients receiving antibiotics for these three conditions should be getting first-line treatment. This accounts for patients who may have allergies or who do not respond well to first-line antibiotics. For example, approximately 10 percent of patients may be allergic to first-line therapies such as amoxicillin and penicillin. (The recommended first-line antibiotics are amoxicillin or amoxicillin/clavulanate for ear and sinus infections, and penicillin or amoxicillin for streptococcal pharyngitis.)
The study also revealed that adults are more likely than children to receive an inappropriate antibiotic for their diagnosis – nearly two thirds of adults with sinus infections and sore throats received an antibiotic that is not recommended for first-line treatment – and that overprescribing of broad-spectrum antibiotics is a big part of the problem (see Figure 1). Macrolides, a class of broad-spectrum antibiotics that includes drugs like azithromycin, were the most commonly prescribed non-first-line antibiotics for all three conditions. However, macrolides are not recommended for sinus or ear infections, and are recommended for sore throats only when patients are allergic to penicillin.
This kind of inappropriate prescribing is problematic for many reasons. For example, a non-first-line antibiotic can expose the patient to more risk, as it may have a lesser chance of effectively treating the infection, or in some cases may be more likely to cause adverse side effects, such as C. difficile. Additionally, there are serious public health concerns. For instance, using broad-spectrum antibiotics, such as azithromycin, when they’re not recommended can accelerate the emergence of resistance.
While the extent of inappropriate antibiotic selection discovered through this analysis is troubling, the findings are an important step forward, providing a comprehensive look at antibiotic selection nationally, including by age and diagnosis. Additionally, these data can serve as a baseline against which we can measure progress moving forward.
We hope that the findings of this research will serve as a helpful tool for health care providers in identifying potential problem areas in their antibiotic prescribing and targeting stewardship efforts to improve antibiotic use. As clinicians – especially those practicing in outpatient settings, where the lion’s share of antibiotic prescribing takes place – we are committed to doing our part to preserve the effectiveness of these lifesaving drugs.
Adam Hersh, MD, PhD is associate professor in the department of pediatrics, division of infectious diseases, at the University of Utah. Jeffrey Linder, MD, MPH, FACP is associate professor of medicine in the division of general internal medicine and primary care at Brigham and Women’s Hospital and Harvard Medical School. Both are members of the expert panel that partnered with CDC and Pew on this analysis.