Dr. Katherine Fleming-Dutra, MD, senior author Deputy Director Office of Antibiotic Stewardship CDC

Antibiotics Still Overprescribed in Many Outpatient Settings

MedicalResearch.com Interview with:

Dr. Katherine Fleming-Dutra, MD, senior author Deputy Director Office of Antibiotic Stewardship CDC

Dr. Fleming-Dutra

Dr. Katherine Fleming-Dutra MD
Deputy Director
Office of Antibiotic Stewardship
CDC

MedicalResearch.com: What is the background for this study?

Response: Antibiotics are life-saving medications that treat bacterial infections. Any time antibiotics are used, they can lead to antibiotic resistance and could cause side effects such as rashes and adverse events, such as Clostridium difficile infection, which is a very serious and sometimes even fatal diarrheal disease. This is why it is so important to only use antibiotics when they are needed. When antibiotics aren’t needed, they won’t help you and the side effects could still hurt you.

A previous study* reported at least 30% of antibiotic prescriptions written in doctor’s offices and emergency departments were unnecessary. However, the data from that study did not include urgent care centers or retail health clinics. We conducted the current analysis to examine antibiotic prescribing patterns in urgent care centers, retail health clinics, emergency departments, and medical offices.

*Fleming-Dutra, K., et al. (2016). “Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011.” JAMA: the Journal of the American Medical Association 315(17): 1864-1873. https://jamanetwork.com/journals/jama/fullarticle/2518263

MedicalResearch.com: What are the main findings?

Response: This study found that all outpatient settings, including urgent care centers, retail health clinics, emergency departments, and medical offices, have opportunities to improve antibiotic prescribing. Visits for respiratory illnesses where antibiotics should not be used still received antibiotics too often in all settings, including almost 46% of the time in urgent care centers, 25% in EDs, 17% in medical offices, and 14% in retail health clinics.

MedicalResearch.com: What should readers take away from your report?

Response: Readers should take away from this report that all settings have opportunities to improve antibiotic use. Antibiotic stewardship, which is the effort to measure and improve antibiotic use, could help reduce unnecessary antibiotic prescriptions in all outpatient settings. CDC’s Core Elements of Outpatient Antibiotic Stewardship provide a framework for implementing antibiotic stewardship in outpatient settings

There are also several things that patients can do to help use antibiotics appropriately:

  • Ask your healthcare provider when antibiotics are needed and when they are not.
  • Talk to your healthcare provider about antibiotic resistance and tell them you are concerned about antibiotic resistance.
  • Don’t pressure your healthcare provider to prescribe antibiotics for you or your child, instead ask what you can do to feel better.
  • Keep yourself and others healthy through preventing the spread of germs, washing your hands, covering your cough, staying home when you feel sick, and getting recommended vaccines.
  • When an antibiotic is prescribed, take it exactly as directed, never save it for later or share it with someone else.

Improving the way healthcare professionals prescribe antibiotics, and the way patients take antibiotics, helps keep us healthy now, helps fight antibiotic resistance, and ensures that life-saving antibiotics will be available for future generations. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work? 

Response: There are likely many reasons why doctors prescribe antibiotics when they are not needed, but in this study we were unable to explore these reasons or how they might affect outpatient settings differently. We know from previous studies that one major reason that doctors prescribe antibiotics when they are not needed in all outpatient settings is that they are worried about patient satisfaction. Doctors may perceive that patient expects antibiotics, and doctors are more likely to prescribe antibiotics when they think the patient wants them. Understanding strategies to help doctors maintain high patient satisfaction while providing the best care for the patient and how to adapt these strategies for settings such as urgent care centers and retail health clinics could help reduce unnecessary antibiotic prescribing.

Additionally, more data are needed to help understand opportunities for improving antibiotic prescribing in other outpatient settings, such as telemedicine, which was not included in this study. 

MedicalResearch.com: Is there anything else you would like to add?

Response: As part of our work to engage all of these outpatient settings in antibiotic stewardship, CDC is actively collaborating with organizations in the urgent care space to identify successes, challenges, and opportunities for improvement related to antibiotic use. In July, CDC met with the Urgent Care Association of America and the Antibiotic Resistance Action Coalition to discuss antibiotic prescribing and use in urgent care settings.

CDC is working with leaders in all of these outpatient settings to identify success stories of antibiotic stewardship implementation that can help other facilities. One such success story from an urgent care is available on CDC’s Safe Healthcare Blog: Christiana Care Sees 39 Percent Decrease in Urgent Care Prescribing After First Year with Antibiotic Stewardship Program.

The authors report no disclosures.

Citation: 

Palms DL, Hicks LA, Bartoces M, et al. Comparison of Antibiotic Prescribing in Retail Clinics, Urgent Care Centers, Emergency Departments, and Traditional Ambulatory Care Settings in the United States. JAMA Intern Med. Published online July 16, 2018. doi:10.1001/jamainternmed.2018.1632

Jul 20, 2018 @ 2:32 pm 

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