Archive for May, 2016

Overuse of Antibiotics

Thursday, May 5, 2016 // Uncategorized

Antibiotics are often prescribed for upper respiratory tract infections inappropriately.  According to the most recent study, 1/3 of antibiotics are prescribed inappropriately.  Overuse of antibiotics leads to resistance of bacteria.  Here is a summary of a recent JAMA article from Physicians First Watch.  Following that is the American College of Physicians informational page for patients on appropriate antibiotic use.

May 5, 2016 Population-Based Estimates of Appropriate and Inappropriate Antibiotic Prescribing Thomas L. Schwenk, MD reviewing Fleming-Dutra KE et al. JAMA 2016 May 3. Tamma PD and Cosgrove SE. JAMA 2016 May 3. Thomas L. Schwenk, MDThe U.S. annual antibiotic prescribing rate in 2010 was about 500 prescriptions per 1000 people; one third of prescriptions were judged to be inappropriate. Thomas L. Schwenk, MDResearch about inappropriate antibiotic prescribing usually focuses on specific conditions and age groups. However, these researchers used several national ambulatory care databases to provide overall population-based estimates that could guide government and professional mandates designed to reduce inappropriate antibiotic prescribing.Researchers assessed appropriateness of antibiotic use in about 184,000 ambulatory visits (not including urgent care centers, “minute” clinics, federal facilities, or long-term care facilities) in 2010 and 2011 using accepted clinical practice guidelines. If guidelines were not available (e.g., for sinusitis), the lowest regional level of antibiotic use was used as a surrogate for appropriateness (almost certainly still an overestimate). For some conditions (e.g., pneumonia), all antibiotic use was deemed to be appropriate.The overall annual rate of antibiotic use was 506 prescriptions per 1000 people, of which roughly two thirds of prescriptions (353 prescriptions/1000 people) were deemed to be appropriate. The overall rate ranged from 423 to 553 prescriptions per 1000 people in the West and South, respectively. Most inappropriate antibiotic use was for acute respiratory conditions (111 prescriptions/1000 people annually).Comment – See more at: http://www.jwatch.org/na41220/2016/05/05/population-based-estimates-appropriate-and-inappropriate#sthash.I2fvkBOG.dpuf

Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and Prevention

 What are acute respiratory tract infections?

Acute respiratory tract infections (ARTIs) are common in adults. ARTIs include bronchitis, sinus infections, sore throat, and the common cold. Most are caused by a virus, not by bacteria.

What are harms related to antibiotic use?

Antibiotics are medicines used to treat illnesses that are caused by bacteria, such as strep throat (medical name: group A streptococcal pharyngitis) or pneumonia. Antibiotics will not work for illnesses caused by viruses, such as the common cold. Antibiotics can cause harm when they are not used the right way. These harms can include:

Side effects: These can be mild, such as upset stomach, diarrhea, or skin rash. However, in some cases they can be very serious and even life-threatening.

High costs: Prescriptions that are not needed increase patients’ out-of-pocket costs. It is estimated that 50% of antibiotic prescriptions are not needed, totaling more than $3 billion in wasted spending.

Antibiotic resistance: When antibiotics are used when they are not needed, germs and bacteria can become resistant to them. This means that common antibiotics will not be able to treat certain illnesses. Antibiotic-resistant bacteria cause more serious illnesses that are harder to cure and can be life-threatening.

Why are so many people prescribed antibiotics when they are not needed?

Because antibiotics have often been used when not needed, many patients expect to receive antibiotics for ARTIs and believe that they need them to feel better. In other cases, clinicians may prescribe antibiotics right away, rather than waiting or testing to see if they are needed.

How did the ACP develop this advice?

The authors looked at research and clinical guidelines related to antibiotic use for ARTIs. This information was used to develop advice for clinicians and patients.

What does the ACP recommend that patients and physicians do?

Reducing unneeded antibiotic prescribing will improve care, lower costs, and help to stop antibiotic resistance. In most patients, symptoms get better in 1 to 2 weeks. Coughs can sometimes last up to 6 weeks. The ACP recommends the following:

•Clinicians should not prescribe antibiotics for patients with bronchitis. Antibiotics should only be used if patients have pneumonia.

•Clinicians should test patients with symptoms that could be strep throat. Because symptoms alone are not reliable, antibiotics should only be prescribed when testing confirms strep throat. Other sore throat infections do not need antibiotics.

•Clinicians should not prescribe antibiotics for sinus infections unless patients have severe symptoms or symptoms that last more than 10 days. Patients whose symptoms improve but eventually get worse may also need antibiotics.

•Clinicians should not prescribe antibiotics for patients with the common cold.

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