CDC Estimates 47 Million Unnecessary Antibiotic Prescriptions Among US Outpatients Annually Interview with:

Dr. Fleming-Dutra MD CDC Dr. Fleming-Dutra MD is a medical epidemiologist with the Office of Antibiotic Stewardship in the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention (CDC). She is also a pediatrician and pediatric emergency medicine physician and has focused on infectious diseases epidemiology and antibiotic stewardship in the outpatient setting in her career at CDC.

Dr. Fleming Dutra What is the background for this study?

Dr. Fleming-Dutra: One of the most urgent public health threats of our time is the emergence of antibiotic-resistant bacteria. The use of antibiotics is the single most important factor leading to antibiotic resistance around the world.  Simply using antibiotics creates resistance.  To combat antibiotic resistance we have to use antibiotics appropriately — only when needed and, if needed, use them correctly.  In 2015, the White House released the National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB), which set a goal for reducing inappropriate outpatient antibiotic use by 50% by 2020.  However, the amount of antibiotic use in the outpatient setting that is inappropriate was unknown. What are the main findings?

Dr. Fleming-Dutra: In this study, we estimate that at least 30% of antibiotics prescribed in doctors’ offices, emergency departments and hospital-based clinics are unnecessary—meaning that no antibiotic was needed at all, which equates to 47 million unnecessary antibiotic prescriptions written annually in these outpatient settings.  Most of those unnecessary antibiotic prescriptions were written for acute respiratory conditions, a key driver of antibiotic overuse. Thus, in order to reach the White House goal of reducing inappropriate outpatient antibiotic use by 50%, a 15% reduction in overall antibiotic use in outpatient settings is needed by 2020. What should clinicians and patients take away from your report?

Dr. Fleming-Dutra: Engagement of both clinicians and patients is critical to improve antibiotic use and combat antibiotic resistance.  Clinicians should continuously re-evaluate their antibiotic prescribing to make sure it is in-line with national guidelines and recent evidence and only prescribe antibiotics when they are needed, and if needed, select the right antibiotic at the right dose, and for the right duration.  Patients should talk to their healthcare providers about antibiotic resistance and ask when antibiotics are needed and when they are not.  Patients should never pressure their healthcare providers for antibiotics, but instead ask what they can do to feel better. What recommendations do you have for future research as a result of this study?

Dr. Fleming-Dutra: In this study we only addressed unnecessary antibiotic use—instances in which antibiotics weren’t needed at all.  Inappropriate use is actually broader than that and includes when an antibiotic is needed, but the wrong antibiotic is chosen, the dose used isn’t right, or the antibiotic is used for too long or too short a time.  Future studies are needed to address inappropriate antibiotic selection, dosing, and duration. Is there anything else you would like to add?

Dr. Fleming-Dutra: :Clinicians, patients, and public health officials all need to work together to improve antibiotic use to preserve these precious resources for future generations. Thank you for your contribution to the community.


Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011

Katherine E. Fleming-Dutra MD, Adam L. Hersh MD, PhD, Daniel J. Shapiro , Monina Bartoces PhD, Eva A. Enns PhD, Thomas M. File MD, Jonathan A. Finkelstein MD, MPH, Jeffrey S. Gerber MD, PhD, David Y. Hyun MD, Jeffrey A. Linder MD, MPH, Ruth Lynfield MD, David J. Margolis MD, PhD, Larissa S. May MD, MSPH, Daniel Merenstein MD, Joshua P. Metlay MD, PhD, Jason G. Newland MD, MEd, Jay F. Piccirillo MD, Rebecca M. Roberts MS, Guillermo V. Sanchez MPH, PA-C, Katie J. Suda PharmD, MS, Ann Thomas MD, MPH, Teri Moser Woo PhD, Rachel M. Zetts , Lauri A. Hicks DO

JAMA May 3, 2016 Volume 315, Number 17

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Last Updated on May 4, 2016 by Marie Benz MD FAAD