Physicians prescribing incorrect antibiotics to treat common conditions

Physicians are inappropriately prescribing broad spectrum antibiotics to treat otitis media, sinusitis and pharyngitis in nearly 50% of cases, according to data published in JAMA Internal Medicine.

Adam L. Hersh, MD, PhD, from the University of Utah, and colleagues reported that these conditions warrant the first-line use of narrow spectrum agents.

“A recent study estimated at least 30% of the antibiotic prescriptions in ambulatory care settings in the United States from 2010 to 2011 were unnecessary,” Hersh and colleagues wrote. “Inappropriate antibiotic prescribing also includes choosing an unnecessarily broad spectrum antibiotic instead of an equally or more effective narrower spectrum alternative. Otitis media, sinusitis, and pharyngitis collectively account for nearly one-third of all antibiotics prescribed in outpatient settings, and professional guidelines recommend narrow spectrum agents as first-line therapy for these conditions. Alternatives to first-line therapy are indicated in selected circumstances, including for patients with penicillin allergy or recent treatment failure.”

The researchers used data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey between 2010 and 2011 regarding visits where antibiotics were prescribed for patients with otitis media, sinusitis or pharyngitis. They classified patients by age, labeling them as pediatric or adult patients, except for otitis media, which was only in pediatric patients ( 19 years old).

Hersh and colleagues followed national guidelines to determine preferred first-line antibiotics for each condition. For otitis media and sinusitis, the first-line recommendation is amoxicillin or amoxicillin with clavulanate. For pharyngitis, the first-line recommendation is penicillin or amoxicillin.

Results showed that appropriate first-line antibiotic prescribing ranged from 37% (95% CI, 32-43) in adult patients with pharyngitis and sinusitis to 67% (95% CI, 63-71) in pediatric patients with otitis media.

Overall, physicians prescribed first-line antibiotics in accordance with guidelines at a rate of 52% (95% CI, 49-55).

The researchers noted that macrolides were the most commonly prescribed non-first-line antibiotic class.

“This study provides evidence of substantial overuse of non-first-line antibiotics for three of the most common conditions in ambulatory care that collectively account for more than 40 million antibiotic prescriptions annually,” Hersh and colleagues concluded. “These findings indicate that the problem of inappropriate antibiotic prescribing includes not only prescriptions that are unnecessary altogether, but also selection of inappropriate agents. As a result, stewardship interventions should address both antibiotic overuse and inappropriate antibiotic selection to improve patient safety and health care quality. Implementation of stewardship strategies is a key component to meeting the National Action Plan goal of reducing inappropriate antibiotic use by 50% in outpatient settings.” – by Chelsea Frajerman Pardes

Disclosures: Hersh reports funding from the CDC, the Agency for Healthcare Research and Quality, Pfizer/Joint Commission, and Merck. None of the other authors reported any relevant financial disclosures.

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