Infectious Disease

Most antibiotic prescriptions were issued without a visit or ID-related code, according to a large study

August 12, 2021

Read for 2 minutes

Source / information

Published by:

Disclosure:
Fischer does not disclose any relevant financial information. Please refer to the study for all relevant financial information from the other authors.

ADD SUBJECT TO EMAIL ALERTS

Receive an email when new articles are published on

Please enter your email address to receive an email when new articles are published on . “data-action =” subscribe “> subscribe

We could not process your request. Please try again later. If this problem persists, please contact customerservice@slackinc.com.

Back to Healio

A study that evaluated more than 22 million outpatient antibiotic prescriptions in the United States found that more than half were unrelated to a doctor visit or an infection-related diagnosis, researchers reported.

“Antibiotic use is one of the most common outpatient medical interventions, with over 259 million antibiotic outpatient prescriptions in the US in 2018.” Michael A. Fischer, MD, MS, who specializes in pharmacoepidemiology and pharmaceutics at Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote, adding that clinicians prescribe antibiotics for 13% of outpatient visits.

Fischer MA, et al.  Open Forum Infect Dis.  2021; doi: 10.1093 / ofid / ofab412.

Fischer MA, et al. Open Forum Infect Dis. 2021; doi: 10.1093 / ofid / ofab412.

“However, overuse of antibiotics increases the risk of antibiotic resistance and side effects,” they wrote. “In addition, every 1,000 outpatient antibiotic prescriptions leads to a visit to the emergency room because of an antibiotic-associated adverse drug reaction. Up to 50% of the antibiotics prescribed may be redundant, which means that in return for the risk of side effects, patients may not even see a clinical benefit. “

To assess the outpatient prescribing of antibiotics in the United States, Fischer and colleagues conducted an observational cohort study with data from a large private insurance company on patients who were prescribed antibiotics between April 1, 2016 and June 30, 2018. According to the study, they identified whether prescriptions were linked to a doctor visit and an infection-related diagnosis; associated with a visit to the doctor, but no infection-related diagnosis; or not in conjunction with a personal visit to the doctor in the 7 days prior to the prescription. They then used multivariable models to assess whether non-visit-based antibiotic prescriptions (NVBAP) differed from visit-based antibiotics based on patient, clinician, or antibiotic characteristics.

The study enrolled 8.6 million people who completed 22.3 million antibiotic prescriptions.

According to Fischer and colleagues, 31% (6.9 million) of antibiotic prescriptions were not associated with a doctor’s visit and 22% (4.9 million) did not contain an infection-related diagnostic code.

They found that NVBAP rates were lower in children than adults, with children ages 0-17 accounting for 16%, adults ages 18-64 years 33%, and adults 65 and over accounting for 34%. In addition, among the most commonly prescribed classes of antibiotics, the NVBAP was highest for penicillins (36%) and lowest for cephalosporins (25%) and macrolides (25%). The study also showed that medical specialists had the highest NVBAP rate (38%), followed by internists (28%), general practitioners (20%), and pediatricians (10%).

“Our results increase concerns about antibiotic overuse and the associated risks of adverse events and antibiotic resistance,” the authors write. “Prescriptions that are issued and filled out without a personal visit or without documentation of an infection are particularly problematic, since antibiotic stewardship interventions may not reach the prescribing doctor at the time of the decision.”

ADD SUBJECT TO EMAIL ALERTS

Receive an email when new articles are published on

Please enter your email address to receive an email when new articles are published on . “data-action =” subscribe “> subscribe

We could not process your request. Please try again later. If this problem persists, please contact customerservice@slackinc.com.

Back to Healio

Related Articles