US study finds high rates of unneeded antibiotic prescribing

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A study has found that there is still a very high level of inappropriate antibiotic prescribing to patients in the US, particularly to older and Black patients.

Sifting through data from around seven billion outpatient visits to doctor’s offices, hospital clinics and emergency departments over a seven-year period, the researchers found that almost three-quarters (74%) of antibiotics prescribed to patients aged 65 years or older, and two-thirds (64%) to Black patients, were unnecessary.

The findings (PDF) suggest efforts to curb unneeded antibiotic use, a key strategy in the fight against rising levels of antimicrobial resistance (AMR), are not working in some parts of the US health system. Antibiotic prescribing remains far higher in the US than many other countries, say the scientists.

Lead researcher Dr Eric Young of the University of Texas Health Science Centre in San Antonio is scheduled to present the findings later this week at the European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) congress in Lisbon.

Of the visits analysed, eight million (11%) resulted in an antibiotic prescription, according to the data, which suggests that the most commonly encountered inappropriate prescription was for  illnesses that are not caused by a bacterial infection, such as non-bacterial skin conditions, viral respiratory tract infections, and bronchitis.

The results also revealed high rates of inappropriate antibiotic prescribing for Hispanic/Latinx patients, with more than half (58%) of cases deemed to be unnecessary.

"We know that physicians typically send patients home with antibiotics if they suspect their symptoms may lead to an infection," said Young.

"This practice becomes more common when patients are unlikely to return for a follow-up visit (i.e. no established care within a clinic or hospital system), which more frequently happens in minority populations," he added.

For older patients, inappropriate antibiotic prescribing in primary care is associated with a wide range of adverse outcomes, including emergency hospital attendances and admissions, adverse drug events, and poorer quality of life, continued Young.

"Our results underscore that strategies to reduce inappropriate prescribing must be tailored for outpatient settings."