Wednesday, August 14, 2013
U.S. Physicians are Awful at Prescribing Antibiotics
Posted by Ryan Radecki
...and the Emergency Department is one of the worst offenders.
This is an analysis of the National Hospital Ambulatory Medical Care Survey, a representative sampling of ambulatory settings across the United States. These authors simply reviewed all the antibiotic prescriptions and diagnosis codes for adult visits to offices, outpatient departments, and Emergency Departments. 10% of visits result in antibiotic prescriptions - and 61% of these prescriptions were broad-spectrum agents (amoxicillin/clavulanate, quinolones, etc.). The largest category of antibiotic prescribing was for acute respiratory infections – and only 32% of those prescriptions were for diagnosis codes where antibiotics were typically indicated. 88% of respiratory diagnoses for which antibiotics were rarely indicated (e.g., bronchitis) received a broad-spectrum antibiotic.
This is retrospective, and the NHAMCS database has limitations – but this is farcical. We're passing out antibiotics without regard to the consequences – and we're overusing broad-spectrum agents when narrow-spectrum agents are likely appropriate. We're far behind Europe in antibiotic stewardship, and the end result is certainly net population harm from over-treatment and induction of microbial resistance.
And, this doesn't even account for pediatric visits – which are probably even worse.
Tragically, physician reimbursement is tied to patient satisfaction – or is an emphasized part of a healthcare business model in for-profit settings – and the evidence clearly indicates patients are more satisfied when they receive antibiotics.(pubmed, pubmed, archives of pediatrics)
Yet another example of perverted incentives degrading medical practice.
"Antibiotic prescribing for adults in ambulatory care in the USA, 2007 – 09"