Your doctor is prescribing antibiotics that won't help – and may harm

Your doctor is prescribing antibiotics that won't help – and may harm
Over a five-year period, 27% of antibiotics were prescribed inappropriately by US doctors
Over a five-year period, 27% of antibiotics were prescribed inappropriately by US doctors
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Over a five-year period, 27% of antibiotics were prescribed inappropriately by US doctors
Over a five-year period, 27% of antibiotics were prescribed inappropriately by US doctors

US doctors haven’t been following the rules when it comes to prescribing antibiotics, according to new research. Despite the rise in antibiotic resistance, between 2017 and 2021 more than a quarter of antibiotics prescribed were for conditions they’re ineffective against.

Much has been made of the global rise in antibiotic resistance and its impact on the delivery of effective treatment, with good reason. The World Health Organization (WHO) reports that the misuse and overuse of antimicrobials, an umbrella term for medications that kill bacteria, parasites, viruses and fungi, is the main driver in the development of drug-resistant pathogens.

A new study by researchers from the University of Michigan (U-M), Northwestern University, and the Boston Medical Center examined US doctors’ antibiotic prescribing habits between 2017 and 2021, during the peak period of the coronavirus pandemic, and uncovered some troubling patterns.

“Our study shows the decline in exposure to inappropriate antibiotic prescriptions during the pandemic was only temporary,” said lead author Kao-Ping Chua, a pediatrician and health care researcher in the Department of Pediatrics at the U-M Medical School.

The researchers analyzed prescriptions for antibiotics dispensed to 37,566,581 American children and adults, 51% of whom were female. For each prescription, they looked at any new diagnosis given to a patient on the day a prescribed antibiotic was dispensed or in the three days before dispensing. If the diagnosis, or diagnoses, didn’t justify the use of antibiotics, it was classified as inappropriate.

What they found was telling:

  • Overall, 60.6 million antibiotic prescriptions were dispensed nationwide during the five-year study period. Over that time, the percentage of conditions for which antibiotics were prescribed inappropriately rose from 25.5% to 27.1%.
  • In December 2019, 1.7% of all patients got antibiotics for inappropriate reasons. That fell to 0.9% of all patients in April 2020 before returning to 1.7% by December 2021.
  • Among diagnoses considered inappropriate for antibiotic treatment, “contact with and suspected exposure to COVID-19” was one of the top two most common reasons between March 2020 and December 2021. Antibiotics kill bacteria; they don’t kill the SARS-CoV-2 virus because, well, it’s a virus.
  • Moreover, 15% of all inappropriately prescribed antibiotics dispensed in the last half of 2021 were for a COVID-19 infection.
  • No diagnosis was offered for 28% to 32% of antibiotic prescriptions filled by patients during the study period, so there was no way of judging appropriateness. The researchers say this may have been because the patient received the prescription at an appointment that wasn’t billed to their insurance, or it was a refill of a past prescription.
  • Of all the patients in the study, 45% received antibiotics at least once in the five-year study period, and 13% received them four or more times.

“Our findings highlight the continued importance of quality improvement initiatives focused on preventing unnecessary antibiotic prescribing and antimicrobial resistance, which kills 48,000 Americans per year,” Chau said.

It’s worth reiterating the dangers of antimicrobial resistance. Not all antibiotics are effective against all types of bacteria. So, when a life-threatening infection is caused by a bacterium that’s resistant to an antibiotic that would ordinarily kill it, that severely limits treatment options and results in significant morbidity and mortality. Further, while scientists and researchers are always looking, discovering new antibiotics rarely happens, so essentially, we’re stuck with what we’ve got.

The best way to contain antimicrobial resistance is to prevent infections in the first place. That includes practicing good hygiene and infection prevention and control procedures and taking vaccines that directly block the transmission of pathogens that cause infections, reducing the chance that a pathogen will mutate to a drug-resistant form.

Remember: Take antibiotics exactly as prescribed, and always take the entire course (don’t skip doses). Don’t save antibiotics for the next time you get sick. Don’t take antibiotics prescribed for someone else. And, don’t take an antibiotic for a virus.

The study was published in the journal Clinical Infectious Diseases.

Source: Michigan Medicine – University of Michigan

Serial job hopper.
I am probably guilty by this study's criteria. I have medical patients who have episodes of atypical pneumonia for whom I will issue azithromycin as soon as they describe their symptoms to my office. Usually physicians or healthcare workers who know the basics of infectious disease. Early in the pandemic my "frequent flyer" pneumonia & bronchiectasis patients did receive a Z pack for an atypical pneumonia that eventually tested positive for SARS-CoV-2. With rapid testing I require a negative COVID-19 test before calling in a Z pack either a home or office rapid test. It complicates normal care, but I do prefer to examine my patients for any airway maladies - it gives me a baseline to follow.
dave be
Early on in the pandemic it was known the one of the main ways people died after getting Covid was from the subsequent pneumonia it developed into. While antibiotics wont do anything against Covid they are a treatment for pneumonia, and there was likely some prophylactic use to keep pneumonia from developing since so few other treatments were available.