Despite a decades-long, widespread effort to reduce inappropriate antibiotic prescribing, new research found only incremental reductions in antibiotic prescribing for adults with acute bronchitis and sore throat.
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, Jeffrey A. Linder, MD, MPH, the studys senior author and a physician and researcher in the Division of General Medicine and Primary Care at Brigham and Womens Hospital in Boston.
Linder said the research shows that although only 10% of adults with sore throats have strep the only common cause requiring antibiotics the national antibiotic prescribing rate for adults with sore throat has remained at 60%. For acute bronchitis, the antibiotic prescribing rate should be close to 0%, but it was 73%.
For a study presented Oct. 3 at the IDWeek conference in San Francisco and published on the website of JAMA Internal Medicine, 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 U.S. between 1996 and 2010. The data represented an estimated 39 million acute bronchitis and 92 million sore throat visits by adults to primary care clinics or EDs.
The researchers found that although visits for sore throats decreased from 7.5% of primary care visits in 1997 to 4.3% of visits in 2010, the overall national antibiotic prescribing rate did not change, with physicians prescribing antibiotics at 60% of visits. There was no change in the percentage of ED visits for sore throat during the time period (2.2% to 2.3%). 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%, while prescriptions for azithromycin, a more expensive antibiotic, increased from being too infrequent to measure reliably in 1997-98 to 15% of visits in 2009-10.
The researchers also noted an increase in the antibiotic prescribing rate in EDs, from 69% to 73%, 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 healthcare system and causes adverse effects for those taking the medication, Barnett said. Most sore throats and cases of acute bronchitis should be treated with rest and fluids and do not require a visit to a physician, he added.
In light of these findings, the authors noted, research efforts are underway to develop and implement interventions that reduce inappropriate antibiotic prescribing for respiratory infections.