How many antibiotic prescriptions are medically unjustified?

antibiotic prescriptions

As antibiotic resistance is becoming more prominent, a recent study investigated the prevalence of inappropriate antibiotic prescriptions in the US.

Antibiotics are used to kill bacteria. However, some commonly used antibiotics can cause some bacteria to become resistant, making it harder to treat their associated illnesses.  These resistant bacteria can survive and increase in number, even in the presence of the antibiotic. This means that taking antibiotics unnecessarily can contribute to antibiotic resistance, which is one of the biggest threats to global public health.

One of the ways to reduce antibiotic resistance includes minimizing inappropriate antibiotic prescriptions, which can occur when patients expect antibiotics for a viral illness, like the common cold. In the last 30 years, countries have started initiatives to reduce the cases of antibiotic resistance, however, there have been studies that indicate a lot of antibiotic prescriptions are still unnecessary. These studies, however, have been based on older diagnostic criteria, replaced in October 2015.

Chua and colleagues conducted a cross-sectional study using data from the 2016 Truven MarketScan Commercial Claims and Encounters database, which is a database for people under the age of 64 who get private health insurance from their employers. They limited their search to children under the age of 17 and adults who were 18-64 years who received pharmacy benefit coverage and were insured for the entire year of 2016. They published their results in The BMJ.

Out of all the patient antibiotic prescriptions, 23.2% of these were unnecessary, where about 1 in 7 prescriptions filled carried at least one inappropriate antibiotic prescription. This evidence shows just how widespread overprescribing antibiotics actually is. However, based on the limitations of this study, the percentage might be much higher. One of the limitations includes the fact that sometimes antibiotics were prescribed in cases that were potentially appropriate. This means that these cases may have carried a percentage that was actually inappropriate.

Written by Unaisa Bhayat, BMedSc

References: Chua K., Fischer M. A., Linder J. A. Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study. BMJ. 2019; 364: k5092

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