Study finds 1 in 3 antibiotic prescriptions are unnecessary

ATLANTA — Nearly a third of antibiotics prescribed in the United States aren’t necessary, according to new data from the Centers for Disease Control and Prevention (CDC).

The CDC study, done in collaboration with Pew Charitable Trusts and other public health and medical experts, examined antibiotic use in doctors’ offices and emergency departments nationwide and found that at least 30% weren’t needed. The findings were published Tuesday in the Journal of the American Medical Association (JAMA).

CDC researchers analyzed the 2010-11 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) to gauge the number of outpatient visits resulting in antibiotic prescriptions by age, region, and diagnosis. Of the estimated 154 million prescriptions for antibiotics written in doctor’s offices and emergency departments each year, about 47 million were unnecessary.

Approximately 44% of the antibiotic prescriptions were written to treat patients with acute respiratory conditions, such as sinus infections, middle ear infections, pharyngitis, viral upper respiratory infections (such as the common cold), bronchitis, bronchiolitis, asthma, allergies, influenza and pneumonia. The CDC estimated that about half of these prescriptions weren’t needed.

Of the more than 184,000 doctor’s office or emergency room visits sampled in the study, 12.6% resulted in antibiotic prescriptions. Per 1,000 population, among all conditions and ages, 506 antibiotic prescriptions were written annually and, of those, 353 were estimated to be appropriate.

The CDC noted that the large amount of excess antibiotic prescriptions written each year put patients at risk for allergic reactions or the sometimes deadly diarrhea, Clostridium difficile.

“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 Tom Frieden said. “Losing these antibiotics would undermine our ability to treat patients with deadly infections, cancer, provide organ transplants, and save victims of burns and trauma.”

The CDC said its findings will aid efforts to improve antibiotic prescribing over the next five years and are part of national initiatives to curb antibiotic overuse. Last year, the White House released The National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB), which aims to halve unnecessary outpatient antibiotic use by 2020.

To achieve the CARB goal, 15% of antibiotic scripts — that is, half of the 30% that aren’t necessary — must be eliminated by 2020, the CDC said.

“Setting a national target to reduce unnecessary antibiotic use in outpatient settings is a critical first step to improve antibiotic use and protect patients,” noted Lauri Hicks, director of the CDC’s Office of Antibiotic Stewardship in the Division of Healthcare Quality Promotion, National Center for Emerging and 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 allocated $160 million in fiscal 2016 for the CDC to implement its activities listed in the CARB plan. The CDC said that with the funding it will work to fight the spread of antibiotic resistance by expediting outbreak detection and prevention in all states; enhancing tracking antibiotic use, resistance mechanisms and resistant infections; and supporting research to address gaps in knowledge.

In addition, the agency will inform providers and the public about antibiotic resistance and proper antibiotic use as well as improve antibiotic use by supporting the expansion and development of new programs and activities at the local level.