Inappropriate Antibiotic Prescription Still Too High

A new study suggests that despite years of persuasion and publicity, antibiotics are still drastically overprescribed for two common complaints: sore throat and bronchitis.

Researchers at of Brigham and Women's Hospital (Boston, MA, USA) reviewed the 1997 to 2010 annual US National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS), searching for data for emergency department (ED) visits as a result of throat soreness or pain events. The surveys included some 8,191 visits, which according to the researchers represent a national figure of some 92 million visits.

The analysis of two US national ambulatory care databases suggests that doctors order antibiotics for about 60% of patients who complain of a sore throat, in many cases for antibiotics more expensive and less effective than penicillin. According to the researchers, the average represents a painfully slow change from 1990, when the rate was 80%, falling to about 70% in 2000. The problem, however, is that only about 10% of sore throats are caused by a pathogen (group A Streptococcus) that actually responds to antimicrobial agents.

The researchers found some good news in the data, in that sore throats as a proportion of primary care visits fell from 7.5% in 1997 to 4.3% in 2010, which indicates that patients are being more selective about seeking care. On the other hand, for bronchitis, the estimated number of annual primary care visits rose from about 1.1 million in 1996 to 3.4 million in 2010. The study was presented at IDWeek 2013, held during October 2013 in San Francisco (CA, USA).

“Clearly what we've done to now (to reduce inappropriate antibiotic use) is not causing change fast enough. The picture is even worse for bronchitis, with some 73% of complaints result in an antibiotic prescription, but the condition never responds to the drugs,” said lead author and study presenter Jeffrey Linder, MD. “For individual patients, the compelling reason not to take antibiotics is they're not going to help you and there's a very real chance they're going to hurt you.”

The NAMCS and NHAMCS are annual, nationally representative, multistage probability surveys of ambulatory care in the United States that collect information on physicians and practices as well as visit-level data, including patient demographics, reasons for visits, diagnoses, and medications. Each visit in the NAMCS/NHAMCS is weighted to allow extrapolation to national estimates.

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