Clinicians prescribed antibiotics without an infection-related diagnosis nearly half of the time and one in five prescriptions were provided without an in-person visit, according to research presented at the recent annual meeting of the Infectious Diseases Society of America (IDWeek 2018).
The study, the first to look at overall outpatient antibiotic prescribing in the United States (US), analysed 509,534 outpatient antibiotic prescriptions given to 279,169 patients by 2,413 clinicians at 514 outpatient clinics over a two-year period.
Specialties included primary care internal medicine, obstetrics/gynecology, family medicine, dermatology, cardiology, and gastroenterology.
Clinicians prescribed 46 per cent of antibiotics without an infection-related diagnosis: 54 per cent of antibiotic prescriptions were infection-related, 29 per cent were non-infection-related, and 17 per cent were associated with no diagnosis.
The most common antibiotic classes prescribed were penicillins (30%), macrolides (23%), cephalosporins (14%), fluoroquinolones (11%), tetracyclines (10%), and sulfonamides (6%).
Clinicians prescribed 20 per cent of antibiotics outside of an in-person visit; prescription encounters were in-person (80%), telephone (10%), order-only (4%), refill (4%), and online portal (1%). The study authors will investigate which of those prescriptions were appropriate in the next phase of research.
“Despite 40 years of randomised controlled trials showing antibiotics don’t help for most coughs and sinus infections, many people are convinced they will not get better without an antibiotic and specifically call the doctor requesting one,” said Dr Jeffrey Linder, lead author of the study. “At busy clinics, sadly the most efficient thing to do is just call in an antibiotic prescription. We need to dig into the data more, but we believe there is a lot of antibiotic prescribing for colds, the flu and non-specific symptoms such as just not feeling well, none of which are helped by antibiotics.”