CDC: One-third of antibiotic prescriptions unnecessary

New CDC data show large percentage of antibiotics in human medicine misused in outpatient settings.

At least 30% of antibiotics prescribed in the U.S. are unnecessary, according to new data published May 3 in the Journal of the American Medical Association (JAMA) by the Centers for Disease Control & Prevention (CDC), in collaboration with Pew Charitable Trusts and other public health and medical experts.

The study analyzed antibiotic use in doctors’ offices and emergency departments throughout the U.S.

CDC researchers found that most of these unnecessary antibiotics are prescribed for respiratory conditions caused by viruses — including the common cold, viral sore throat, bronchitis, sinus infections and ear infections — that do not respond to antibiotics. These 47 million excess prescriptions each year put patients at needless risk for allergic reactions or the potentially deadly diarrhea-causing bacteria Clostridium difficile.

The researchers also estimated the rate of inappropriate antibiotic use in adults and children by age and diagnosis. These data will help inform efforts to improve antibiotic prescribing over the next five years.

“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,” CDC director Dr. Tom Frieden warned. “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.”

Dr. Mark Ebell, a professor of epidemiology in the University of Georgia College of Public Health and a family physician, said, “I’m surprised it is only a third." The overprescription of antibiotics has important detrimental effects, he explained.

“By overusing antibiotics, we increase resistance of bacteria to antibiotics,” he said. “We waste money. We sometimes cause very serious adverse effects like allergic reactions or C. difficile infection.”

Ebell added, “We tend to focus a lot on diagnosis and treatment in medicine, but I think that the importance of making a good prognosis is underappreciated. Patients often ask, ‘When am I going to feel better, doc?’ — and (they) deserve an accurate answer.”

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CARB action plan

In 2015, the White House released The National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB), which set a goal of reducing inappropriate outpatient antibiotic use by at least half by 2020. This means that 15% of antibiotic prescriptions (or half of the 30% that are unnecessary) must be eliminated by 2020 to meet the CARB goal.

As part of the effort to achieve the national goal, CDC researchers analyzed the 2010-11 "National Ambulatory Medical Care Survey" and the "National Hospital Ambulatory Medical Care Survey" to determine the number of outpatient visits resulting in antibiotic prescriptions by age, region and diagnosis in the U.S. from 2010 to 2011. They found that:

* Of the estimated 154 million prescriptions for antibiotics written in doctor’s offices and emergency departments each year, 30% are unnecessary. This finding creates a benchmark for improving outpatient antibiotic prescribing and use.

* About 44% of outpatient antibiotic prescriptions are written to treat patients with acute respiratory conditions, such as sinus infections, middle ear infections, pharyngitis, viral upper respiratory infections (i.e., the common cold), bronchitis, bronchiolitis, asthma, allergies, influenza and pneumonia. An estimated half of these outpatient prescriptions are unnecessary.

“Setting a national target to reduce unnecessary antibiotic use in outpatient settings is a critical first step to improve antibiotic use and protect patients,” said Lauri Hicks, director of the Office of Antibiotic Stewardship in the Division of Healthcare Quality Promotion — part of CDC's National Center for Emerging & Zoonotic Infectious Diseases — and commander in the U.S. Public Health Service. “We must continue to work together across the entire health care continuum to make sure that antibiotics are prescribed only when needed and, when an antibiotic is needed, that the right antibiotic, dose and duration are selected.”

Congress, recognizing the urgent need to combat antibiotic resistance, appropriated $160 million in new funding in fiscal 2016 for CDC to implement its activities listed in the National Action Plan for Combating Antibiotic-Resistant Bacteria.

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