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Study: Antibiotics Still Prescribed at 'Alarming Rates' in Outpatient Settings

By Hospital Safety Insider  
   March 08, 2018

While the researchers found no change in the overall annual antibiotic prescribing rate, or the prescribing rate of any one drug in particular, they did observe variation in rates of antibiotics prescribed based on the season.

This article was originally published in HCPro's Hospital Safety Insider March 8, 2018.

A study published in Infection Control & Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America (SHEA), has concluded that antibiotics continue to be prescribed at "alarming rates" in outpatient settings. Researchers found this increase in prescriptions occurred even though there has been a recent push to limit use of these drugs due to antibiotic resistance.

The authors of the study, published online Thursday, say their findings suggest that "current initiatives to improve the use of antibiotics in outpatient settings may not be enough to change clinicians’ prescribing practices." And they feel clinicians must be better equipped "with the tools and knowledge to know when antibiotics are needed."

"It is one of the most important steps towards reducing antibiotic-resistant bacteria, as well as adverse events associated with these powerful drugs,” the study's lead author, Michael Durkin, MD, MPH, assistant professor of medicine at Washington University School of Medicine, said in a statement released by SHEA. “There has been progress in reducing antibiotic prescriptions in hospitals, but there needs to be more research and attention on how to address this issue in the outpatient setting.”

The researchers conducted a retrospective analysis of outpatient antibiotic prescriptions from administrative claims data from 2013-2015, using a sample from Express Scripts Holding Company’s database of insured members. They tracked monthly prescription rates for all antibiotics, in addition to the five most commonly prescribed antibiotics: azithromycin, amoxicillin, amoxicillin/clavulanate, ciprofloxacin, and cephalexin.


Related: Cigna's Express Scripts Purchase Intensifies PBM Market Shakeup


While the researchers found no change in the overall annual antibiotic prescribing rate, or the prescribing rate of any one drug in particular, they did observe variation in rates of antibiotics prescribed based on the season. Overall, they say, seasonal prescribing peaked in February and was 42% higher than the lowest rate in September.

That, the researchers argue, makes sense despite other studies suggesting the spikes in antibiotic prescriptions during winter could be chalked up to inappropriate treatment for viral conditions. They pointed out, for example, that azithromycin, amoxicillin, and amoxicillin/clavulanate were most often prescribed during February, when pneumonia is more common. And ciprofloxacin and cephalexin were most often prescribed in the summer months, when skin and soft-tissue infections are more common.

“If quality improvement guidelines were sufficient to improve antibiotic prescribing practices, then we would have expected to see an overall decrease in antibiotic prescribing rates over time. However, standalone educational materials are rarely successful for changing clinician behavior,” Durkin stated. “A more rigorous framework and greater investment of resources is needed to substantially improve outpatient antibiotic prescribing rates, helping to combat antibiotic resistance and improve patient safety.”

He advocates that healthcare systems incorporate the CDC's Core Elements of Outpatient Antibiotic Stewardship, recommendations that include education, creating accountability for optimizing antibiotic prescribing, implementing at least one policy to improve anti-biotic prescribing, and tracking and reporting antibiotic unitization to providers.

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