Antibiotic use in America: 30 percent of prescriptions 'inappropriate'

Antibiotic resistance is big news and a genuine concern. New research, published in JAMA, fleshes out these worries and, for the first time, puts some statistics behind the issue. Should there be more legislation to curb the overuse of antibiotics? How do the official plans of the White House measure up to the state of play?

Antibiotic resistance is perhaps one of the greatest issues facing modern medicine.

Antibiotics have been an invaluable line of defense against infection since penicillin was first used in the 1920s.

Millions of people across the world have enjoyed extended lives, thanks in part to these life-saving drugs. 

Over recent years, however, with the rise in antibiotic resistance, these wonder drugs have turned the tables on us.

As it stands, antibiotic-resistant infections affect 2 million people and are associated with an estimated 23,000 deaths in the United States each year.

Many experts, including those from the Centers for Disease Control and Prevention (CDC), believe that antibiotic usage is the main cause of these so-called superbugs.

In 2011, in the U.S. alone, 262 million outpatient antibiotic prescriptions were dispensed, making up around 80 percent of the total antibiotic prescriptions.

Although there have been concerns for some time that many of these prescriptions were filed unnecessarily, the exact figures were not known. New research aims to plug this knowledge gap.

A team, led by Dr. Katherine E. Fleming-Dutra at the CDC, picked through data from the 2010-2011 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey. They set out to uncover the number of antibiotic courses that were being prescribed for children and adults incorrectly.

What conditions are antibiotics being prescribed for?

From the 184,032 visits that the researchers viewed, overall, 12.6 percent resulted in an antibiotic prescription.

The complaints that most commonly received antibiotics include:

• Sinusitis: 56 per 1,000 population - the most common single condition to receive antibiotics
• Suppurative otitis media (ear infection): 47 per 1,000 population
• Pharyngitis (infection of the upper throat): 43 per 1,000 population
• All acute respiratory conditions combined: 221 per 1,000 population.

Overall, from 2010-2011, an estimated 506 antibiotic prescriptions were written per 1,000 people. Of these, 353 were deemed by the research team to have been appropriate, leaving 153 that were considered to be avoidable.

"Half of antibiotic prescriptions for acute respiratory conditions may have been unnecessary, representing 34 million antibiotic prescriptions annually. Collectively, across all conditions, an estimated 30 percent of outpatient, oral antibiotic prescriptions may have been inappropriate."

Dr. Katherine E. Fleming-Dutra

The future of antibiotic use

An accompanying editorial, written by Drs. Pranita D. Tamma and Sara E. Cosgrove, begins with a quote from Lord Kelvin: "If you cannot measure it, you cannot improve it."

This recent study provides that vital measurement; now that the size of the problem is better understood, researchers can look to the future and help shape the official response to the crisis.

The U.S. government recognizes the importance of this medical issue and have created a White House National Action Plan for Combating Antibiotic-Resistant Bacteria.

According to the document, their goal is to point the government in the right direction, but it is also to "guide action by public health, healthcare, and veterinary partners in a common effort to address urgent and serious drug-resistant threats that affect people in the U.S. and around the world."

According to the current study, there is a long way to go before the healthcare profession meets the targets as set out in the White House's plan.

"A 15 percent reduction in overall antibiotic use would be necessary to meet the White House National Action Plan for Combating Antibiotic-Resistant Bacteria goal of reducing inappropriate antibiotic use in the outpatient setting by 50 percent by 2020."

Dr. Katherine E. Fleming-Dutra

The authors hope that their findings can help steer "antibiotic stewardship programs in ambulatory care by public health and healthcare delivery care systems in the next 5 years." 

There is clearly a long road ahead but, as the editorial points out, it is essential that the problem is addressed and managed in a swift and orderly manner.

The authors of the editorial believe that any successful plan to reduce antibiotic resistance must target both clinicians and patients in order to work toward a common goal.

References:

1.  Prevalence of inappropriate antibiotic prescriptions among U.S. ambulatory care visits, 2010-2011, Katherine E. Fleming-Dutra et al.,JAMA, doi: :10.1001/jama.2016.4151, published online 3 May 2016.
2.  Addressing the Appropriateness of Outpatient Antibiotic Prescribing in the United States, Pranita D. Tamma, et al., JAMA, published online 3 May 2016.
3. JAMA new release, accessed 3 May 2016.
4.  Additional source: CDC, Antibiotic / antimicrobial resistance, accessed 3 May 2016.
5.  Additional source: The White House, National action plan for combating antibiotic-resistant bacteria, accessed 3 May 2016.