Antibiotic resistance is a major concern worldwide. It has been well established that antibiotic use increases the likelihood for an individual to develop bacterial resistance. The majority of antibiotic prescribing takes place in primary care, and physicians and PAs have been encouraged to prescribe antibiotics more rationally, only when necessary.
In 2015, The Pew Charitable Trusts convened a panel of experts that included representatives from the Centers for Disease Control and Prevention (CDC) and other public health and medical experts to analyze current outpatient antibiotic prescribing habits in the United States, determine targets for reducing inappropriate prescribing, and identify steps needed to reach these targets.
The results pointed out that approximately 13 percent of all outpatient office visits in the U.S. result in antibiotic prescriptions. About 30 percent of these — 47 million prescriptions — are unnecessary.
Approximately 44 percent of outpatient antibiotic prescriptions are written to treat patients with acute respiratory conditions, ranging from sinus infections to pneumonia. Half of these prescriptions are unnecessary because viral illnesses, such as colds, do not respond to antibiotics. It was also found that antibiotics are frequently overprescribed in elderly patients.
Although symptomatic treatment is recommended for uncomplicated cases of the common cold (bed rest, plenty of fluids, gargling with warm salt water, and aspirin or acetaminophen to relieve headache or fever), a recent study of seniors in Ontario, Canada, revealed that nearly 1 in 2 patients who visited a family physician for a nonbacterial infection were prescribed an antibiotic.
Between January and December 2012, researchers conducted a retrospective analysis of linked administrative healthcare data from primary care physicians (PCPs) in Ontario. A multivariable logistic regression model with generalized estimating equations was used to examine whether prescribing rates varied by physician characteristics, accounting for clustering of patients among physicians and adjusting for patient-level covariates.
The cohort included 8,990 PCPs and 185,014 patients (age 66 years and older) who presented with nonbacterial acute upper respiratory tract infections (AURIs), including the common cold (53.4 percent), acute bronchitis (31.3 percent), acute sinusitis (13.6 percent) or acute laryngitis (1.6 percent).
Overall, results indicated that 46 percent of patients were prescribed antibiotics, mainly broad-spectrum agents.
Mid- to late-career physicians were more likely to prescribe antibiotics than early-career physicians (5.1 percent versus 4.6 percent, respectively), as were physicians who saw 25 to 44 patients per day or 45 or more patients per day compared with those who saw fewer than 25 patients per day (3.1 percent versus 4.1 percent, respectively). Patients were also more likely to receive an antibiotic prescription from physicians who were trained outside of the U.S. or Canada.
The number of antibiotic-resistant organisms has increased in the past decade, which may be related to an unacceptably high proportion of patients with viral respiratory infections who are still receiving antibiotics. According to Dr. Michael Silverman, author of the study, antibiotics are being prescribed too often for conditions that they cannot help despite published professional guidelines that discourage this practice.
Steps to resolve this might include targeted interventions to reduce inappropriate antibiotic prescribing, which would require understanding physician factors associated with this practice.
