No Reduction In Antibiotic Prescribing Habits Interview with:

Michael Durkin, MD MPH Washington University School of Medicine St. Louis

Dr. Durkin

Michael Durkin, MD MPH
Washington University School of Medicine
St. Louis What is the background for this study? What are the main findings?

Response: The aim of this study was to evaluate overall national outpatient antibiotic prescribing trends using a pharmacy benefits manager (Express Scripts). We wanted to evaluate if antibiotic prescribing had decreased as a result of increase physician awareness of antibiotic prescribing. Specifically, the ABIM choosing wisely campaign overlapped with our study period.

We did not see any significant reductions in antibiotic prescribing during the 3-year study period. This is a little disappointing given that the CDC estimates that 30% of outpatient antibiotic prescriptions are inappropriate.

We also saw some seasonal variation in antibiotic prescribing. This isn’t particularly novel. But it is important to note, as some of these prescriptions represent providers writing antibiotics for likely viral conditions. What should readers take away from your report?

Response: I’d like readers to know that clinical practice guidelines may not be sufficient to improve antibiotic prescribing in outpatient settings. There are lots of free resources on the CDC and ABIM websites that can be used as a starting point. However, more dedicated efforts are required to ultimately improve antibiotic prescribing. If providers are looking for a framework, we recommend checking out the CDC Core Elements for Outpatient Antibiotic Stewardship. What recommendations do you have for future research as a result of this work?

Response: Our research was over a limited time frame and did not include claims data to adequately understand the rationale for each antibiotic prescription. It would be nice for follow up studies to validate that many of these prescriptions are not necessary. Is there anything else you would like to add?

 Response: I’d like to add that our findings should not discourage releasing clinical practice guidelines or educational materials about antibiotic stewardship, rather we hope that this highlights that further research is required to understand how to best implement and disseminate this information to front-line providers. 

Citations: Michael J. Durkin, S. Reza Jafarzadeh, Kevin Hsueh, Ya Haddy Sallah, Kiraat D. Munshi, Rochelle R. Henderson, Victoria J. Fraser. Outpatient Antibiotic Prescription Trends in the United States: A National Cohort Study. Infection Control & Hospital Epidemiology, 2018; 1 DOI: 10.1017/ice.2018.26

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