Healthcare News & Insights

Docs overprescribing of ‘big gun’ antibiotics leads to drug-resistant bacteria

When prescribing antibiotics, six out of 10 physicians opt for the big guns. That’s despite the fact the drugs are ineffective in 25% of the cases, because the infections were caused by viruses. This presents an even bigger problem — the over-prescribing of broad-spectrum antibiotics contributes to antibiotic-resistant bacteria.

156218085Don’t just take our word for it — this comes from a recent study in the Journal of Antimicrobial Chemotherapy.

In the study, the researchers examined 2007-2009 data on patients who were 18 and older from the National Ambulatory and National Hospital Ambulatory Medical Care Surveys.

What was discovered is that patients were prescribed antibiotics during 101 million ambulatory visits annually, which represents 10% of all visits. And of that 10%, 61% were prescribed broad-spectrum antibiotics, which are capable of killing multiple kinds of bacteria.

They also found that many of the broad-spectrum antibiotics were for respiratory conditions (41%), skin conditions (18%) and urinary tract infections (9%).

While some infections are caused by viruses and are unaffected by antibiotics, even in cases where antibiotics are indicated, the researchers found the physicians often prescribe broad-spectrum antibiotics when narrow-spectrum antibiotics would be sufficient. Reason: Uncertainty about the cause of the infection.

However, this overuse of broad-spectrum antibiotics contributes to the development of antibiotic-resistance bacteria — a serious problem in both children and adults.

Successful antibiotic prescription program

One facility found a way to significantly reduce inappropriate antibiotic prescribing through a quality improvement program.

The program, which was instituted by Cincinnati Children’s Hospital Medical Center, was based on 2011 guidelines issued by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America on treating kids who develop pneumonia outside of the hospital, called community-acquired pneumonia.

It recommends that doctors prescribe ampicillin as a first line of treatment unless circumstances require otherwise, because of an underlying medical condition. Ampicillin only affects a select group of bacteria.

Choosing this drug could help prevent antibiotic resistance, because if bacteria become resistant to ampicillin, there are still plenty of other antibiotics that could work on the organisms that ampicillin doesn’t affect. Broad spectrum antibiotics leaves physicians with fewer options to treat resistant bacteria.

2 key elements

The quality improvement program at Cincinnati Children’s Hospital consisted of two key elements:

  • educating senior-level physicians on the new antibiotic prescribing rules and creating a quick reference guide for physicians-in-training, and
  • updating the hospital’s electronic medical records so they defaulted to the recommended antibiotics when a patient was diagnosed with pneumonia — previously, a broad-spectrum drug was the default.

The researchers tracked patients’ treatment six months prior to starting the program and for nine months after. In total, they studied 217 children with pneumonia.

Before the program was implemented, doctors never really followed the national guidelines:

  • emergency room physicians’ prescribing practices were almost never consistent with the recommendations, and
  • hospital floor physicians followed the practices about 30 percent of the time.

But within six months of introducing the quality improvement program, doctors were meeting national guidelines for treatment of childhood pneumonia 100% of the time, according to a study in Pediatrics.

Cincinnati Children’s Hospital Medical Center’s program can serve as a model for other hospitals looking to get their antibiotic prescribing practices up to speed with current recommendations.

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