Here is a statistic that medical students should take to heart: One in every three prescriptions written for antibiotics in the United States (US) is unnecessary.
That’s the conclusion of a recent study published in the Journal of the American Medical Association (JAMA) by the Centers for Disease Control and Prevention (CDC) and Pew Charitable Trusts (http://www.cdc.gov/media/releases/2016/p0503-unnecessary-prescriptions.html). The study looked at antibiotic prescribing in both outpatient physician practices and emergency departments. Most prescriptions were written for viral infections—which do not respond to antibiotics. Not only can inappropriate prescribing lead to adverse patient reactions (e.g. allergic reactions, Clostridium difficile infection), it wastes money and adds to the burden of antibiotic resistance worldwide.
In an effort to promote appropriate antibiotic prescribing, New York’s “Get Smart (Know When Antibiotics Work)” Campaign is doing outreach to healthcare providers. This campaign is a collaborative effort between the New York State Department of Health (NYSDOH) and CDC. CDC has provided grant funding to New York State in an effort to combat antibiotic resistance and the “superbugs” that arise from avoidable prescribing of antibiotics. The concern is that we face a frightening future where many antibiotics we have come to rely on to fight infection will no longer be effective.
This is a timely issue: in fiscal year 2016, Congress appropriated $160 million for CDC to fight antibiotic resistance, to promote antibiotic stewardship, and to protect patients’ health. http://www.cdc.gov/drugresistance/solutions-initiative/index.html
To get a handle on where New York stands, the New York “Get Smart (Know When Antibiotics Work) Campaign” analyzed 2013 Medicaid claims data on prescribing for adult upper respiratory infections and found that in 11 counties in New York State, over 55 percent of provider visits resulted in antibiotics being prescribed for adults with upper respiratory infections (URIs). URIs are generally viral in nature, meaning antibiotics would be ineffective treatment.
In fact, the Society for Healthcare Epidemiology of America (SHEA) wrote this 2015 article, suggesting that some suboptimal prescribing behaviors may be learned early in a prescriber’s career. “Physicians’ inappropriate prescribing patterns appeared to differ by medical specialty and to be established early, likely during medical school or residency,” said Tamar Barlam, MD, lead author of the study, and Director of the Antimicrobial Stewardship Program for Boston Medical Center and Associate Professor of Medicine at Boston University School of Medicine. “Instituting aggressive interventions in training or practice at the right time and to the right physicians could improve antibiotic use and efficacy of antibiotic stewardship in outpatient settings.”
The American College of Physicians (ACP) and the CDC recently published an article giving prescriber advice on appropriate antibiotic use for acute respiratory tract infection in adults, which can be seen here:
http://annals.org/article.aspx?articleid=2481815
What was some of the advice given? In addition to other suggestions, the ACP/CDC advice urged clinicians not to prescribe antibiotics for patients with the common cold and not to perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected.
Some healthcare providers say they prescribe antibiotics even when they know they are not indicated because of pressure from patients for a post-office visit “takeaway”. There is concern that providers might get negative reviews on patient satisfaction forms if patients are denied antibiotics.
The New York “Get Smart” Campaign can help bridge that gap and foster greater provider-patient communication with materials that can help educate patients about antibiotic resistance.
(Here are two examples of materials that may be downloaded or ordered from the New York “Get Smart” Campaign” including a “Viruses or Bacteria?” chart:
and the “viral prescription pad” which gives patients a “takeaway”:
If you are interested in joining the “Get Smart” effort in New York State or becoming a “champion” of appropriate antibiotic prescribing (setting an example helps every community), please contact Mary Beth Wenger, Project Coordinator of the New York “Get Smart” Campaign at 518-474-1036 or email her at: marybeth.wenger@health.ny.gov