Public Release:  High rates of unnecessary prescribing of antibiotics observed across the US

Researchers find large discrepancy between outpatient visits requiring antibiotics and national prescribing rates

Brigham and Women's Hospital

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Boston, MA - For decades, there has been a significant effort led by the Centers for Disease Control and Prevention and others to reduce inappropriate antibiotic prescribing. Despite this work, new research from Brigham and Women's Hospital (BWH) finds only incremental improvement in antibiotic prescribing for adults with acute bronchitis and sore throat. These findings were presented at IDWeek on October 3, 2013 and the sore throat data was published online in JAMA Internal Medicine.

"We know that antibiotic prescribing, particularly to patients who are not likely to benefit from it, increases the prevalence of antibiotic-resistant bacteria, a growing concern both here in the United States and around the world," said Jeffrey A. Linder, MD, MPH, a physician and researcher in the Division of General Medicine and Primary Care at BWH and senior author of the paper. "Our research shows that while only 10 percent of adults with sore throat have strep, the only common cause of sore throat requiring antibiotics, the national antibiotic prescribing rate for adults with sore throat has remained at 60 percent. For acute bronchitis, the right antibiotic prescribing rate should be near zero percent and the national antibiotic prescribing rate was 73percent."

Linder and lead author, Michael L. Barnett, MD, measured changes in the prescribing of antibiotics for adults with sore throat and acute bronchitis using nationally representative surveys of ambulatory care in the United States from 1996 - 2010. The data represented an estimated 39 million acute bronchitis and 92 million sore throat visits by adults to primary care clinics or emergency departments.

The researchers found that although visits for sore throats decreased from 7.5 percent of primary care visits in 1997 to 4.3 percent of visits in 2010, the overall national antibiotic prescribing rate did not change with physicians prescribing antibiotics at 60 percent of visits. There was no change in the percentage of emergency department visits for sore throat during the time period (2.2-2.3 percent). The number of acute bronchitis visits increased from 1.1 million visits in 1996 to 3.4 million visits in 2010.

The data also show that prescriptions of penicillin, the antibiotic recommended to treat strep throat, remained at 9 percent while prescribing for azithromycin, a more expensive antibiotic, increased from being too infrequent to measure reliably in1997-1998 to 15 percent of visits in 2009-2010.

The researchers also noted an increase in the antibiotic prescribing rate in emergency rooms, from 69 percent to 73 percent, during the same 14-year period.

"In addition to contributing to the prevalence of antibiotic resistant bacteria, unnecessary use of antibiotics also adds financial cost to the health care system and causes adverse effects for those taking the medication," said Barnett. Most sore throats and cases of acute bronchitis should be treated with rest and fluids and do not require a visit to the doctor," he added.

In light of these findings, research efforts are now underway to develop and implement interventions that reduce inappropriate antibiotic prescribing for respiratory infections.

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Dr. Linder's work on acute respiratory infections is supported by grants from the National Institutes of Health (RC4 AG039115), the National Institute of Allergy and Infectious Diseases (R21 AI097759), and the Agency for Healthcare Research and Quality (R18 HS018419).

Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare. BWH has more than 3.5 million annual patient visits, is the largest birthing center in New England and employs more than 15,000 people. The Brigham's medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in patient care, quality improvement and patient safety initiatives, and its dedication to research, innovation, community engagement and educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), BWH is an international leader in basic, clinical and translational research on human diseases, involving nearly 1,000 physician-investigators and renowned biomedical scientists and faculty supported by $640 million in funding. For the last 19 years, BWH ranked second in research funding from the National Institutes of Health (NIH) among independent hospitals. BWH continually pushes the boundaries of medicine, including building on its legacy in organ transplantation by performing the first face transplants in the U.S. in 2011. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies, OurGenes and the Women's Health Initiative. For more information and resources, please visit BWH's online newsroom.

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