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Antibiotic Use Soars In Ambulatory Care

MANAGED CARE October 2013. © MediMedia USA
News & Commentary

Antibiotic Use Soars In Ambulatory Care

The misuse of antibiotics continues apace, with many physicians inclined to prescribe broad-spectrum antibiotics for conditions that might need a drug with a narrower focus or that require no antibiotic at all. There seems to be a tie-in with insurance coverage, as well, says a study in the Journal of Antimicrobial Chemotherapy.

“We … found that physicians more frequently prescribe broad-based agents to patients with private insurance,” the researchers note. “This may reflect physicians’ awareness of the financial burdens, including prescription copays.”

Broad-spectrum antibiotics were prescribed 60% of the time between 2007 and 2009. Researchers looked at about 100 million ambulatory visits per year.

“In our study, broad-spectrum antibiotics were selected during almost 80% of visits for respiratory conditions for which antibiotics rarely provide benefit,” says the study “Antibiotic Prescribing for Adults in Ambulatory Care in the U.S.A., 2007–09.” It continues: “This amounts to nearly 27 million prescriptions annually, and collectively is more than one out of every four ambulatory antibiotic prescriptions, driven predominately by macrolides and quinolones.”

Other broad-spectrum antibiotics included broad-spectrum penicillins like amoxicillin and clavulanate, cephalosporins, and lincomycin derivatives.

“The use of antibiotics for respiratory conditions where they are rarely indicated remained high (46%) even when we excluded patients with comorbidities,” the study states. “Additionally, there was substantial regional variability in antibiotic use for these conditions; antibiotics were prescribed during only 38% of visits in the West compared with 60% of visits in the South.”

The authors say that this should be investigated. “This may reflect regional differences in the impact of national interventions focused on judicious antibiotic use.”

Education can work, they argue. The rate of visits to doctors’ offices that have resulted in an antibiotic being prescribed has declined in the last two decades.

What’s happening in ambulatory care needs to be addressed, since overuse of “can cause adverse events without providing any benefit.”