MedicalResearch.com Interview with:
Dr. Pranita D. Tamma
Assistant Professor of Pediatrics
Director, Pediatric Antimicrobial Stewardship Program
The Johns Hopkins University School of Medicine
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: A study examining the impact of antibiotics prescribed for nearly 1500 adult patients admitted to The Johns Hopkins Hospital found that adverse side effects occurred in a fifth of them, and that nearly a fifth of those side effects occurred in patients who didn’t need antibiotics in the first place.
In the study, the researchers evaluated the electronic medical records of 1488 adults admitted to the general medicine services at The Johns Hopkins Hospital between September 2013 and June 2014. The patients were admitted for reasons ranging from trauma to chronic disease, but all received at least 24 hours of antibiotic treatment.
The researchers followed patients for 30 days after hospital discharge to evaluate for the development of antibiotic-associated adverse events. To determine the likelihood that an adverse reaction was most likely due to antibiotics and to identify how many adverse reactions could be avoided by eliminating unnecessary antibiotic use, two infectious disease clinicians reviewed all of the data.
MedicalResearch.com: What are the main findings?
Response: They concluded that overall 20 percent of patients receiving antibiotics experienced one or more adverse effects, noting that for each additional ten days of antibiotics, the risk of side effects increased by 3 percent. Gastrointestinal, kidney and blood abnormalities were the most common side effects experienced, accounting for 42 percent, 24 percent and 15 percent of adverse effects experienced respectively. Patients were observed for up to 90 days for the development of Clostridium difficile infection- a cause of diarrhea that can sometimes be severe- or the development of new infections due to multidrug-resistant organisms as these often take longer than other adverse events to become apparent. A total of 4% and 6% of patients developed C. difficile infections and future multidrug-resistant organism infections, respectively. While no deaths were attributed to any antibiotic side effects in this study, the researchers say, 24% of patients had prolonged hospital stays as a result of their adverse events, 3% of patients experienced additional hospital admissions, 9% of patients required additional emergency department or clinic visits, and 61% or patients needed additional diagnostic studies.
Beyond the emotional and financial costs of dealing with the side effects, the researchers also concluded that 19% of antibiotics prescribed to the patients were clinically unnecessary, meaning that the two reviewing infectious disease experts found no indication of bacterial infections in these patients. The rate of adverse effects in this group was the same as in the overall group – 20%, according to Tamma.
MedicalResearch.com: What should clinicians and patients take away from your report?
Response: Their report published June 12, 2017 in JAMA Internal Medicine, adds to growing evidence that antibiotics are not benign and that clinicians too often fail to weigh both risks and benefits of antibiotics before prescribing them.
“Too often clinicians prescribe antibiotics even if they have a low suspicion for a bacterial infection thinking that even if antibiotics may not be necessary, they are probably not harmful. But that is not always the case. Antibiotics have the potential to cause real harm to patients,” says Pranita Tamma, M.D., M.H.S, lead author and Director of the Pediatric Antimicrobial Stewardship Program at The Johns Hopkins Hospital. “Every time we are thinking about prescribing an antibiotic we need to pause and ask ourselves, does this patient really need an antibiotic? And, if the patient develops an antibiotic-associated adverse reaction, even though that is of course unfortunate, we should be able to take some comfort in knowing that at least the antibiotic was truly indicated” she adds.
MedicalResearch.com: Is there anything else you would like to add?
Response: The Hopkins team cautioned that their study may actually be underestimating the number of antibiotic-associated adverse effects that occur in the general population because The Johns Hopkins Hospital has a robust Antibiotic Stewardship Program that guides clinicians with making wise antibiotic choices.
“In general, we would expect our hospital to have lower numbers of antibiotic-associated side effects than at hospitals without antibiotic stewardship programs because our stewardship team assists health care providers with optimizing the administration of antibiotics and we tend to recommend targeted therapies for shorter periods of time,” says Sara Cosgrove, MD, MS, senior author on this work and the Director of the Antimicrobial Stewardship Program at The Johns Hopkins Hospital.
Tamma says the absence of universal electronic records in all clinics also may have contributed to underestimation of harmful effects associated with antibiotics. “There may have been more visits for adverse effects that we were unable to track,” she says.
In addition to raising further awareness about unnecessary prescribing among physicians, Tamma says the new study results should also encourage patients to ask questions and understand the risks. “I think it’s good for patients to ask their doctors about potential side effects and how to recognize them, she says. “That alone could reduce a large portion of unnecessary antibiotic prescribing.”
Other researchers involved in this study include Edina Avdic, David X. Li, Kathryn Dzintars and Sara E. Cosgrove of the Johns Hopkins Medical Institutions.
The researchers report no conflicts of interest.
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Tamma PD, Avdic E, Li DX, Dzintars K, Cosgrove SE. Association of Adverse Events With Antibiotic Use in Hospitalized Patients. JAMA Intern Med. Published online June 12, 2017. doi:10.1001/jamainternmed.2017.1938
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