At least 30 per cent of antibiotics prescribed in the US are unnecessary, according to new data published in the Journal of the American Medical Association (JAMA) by the Centres for Disease Control and Prevention (CDC), in collaboration with Pew Charitable Trusts and other public health and medical experts.

The study analysed antibiotic use in doctors’ offices and emergency departments throughout the US. CDC researchers found that most of these unnecessary antibiotics are prescribed for respiratory conditions caused by viruses – including common colds, viral sore throats, bronchitis, and sinus and ear infections – which do not respond to antibiotics. These 47 million excess prescriptions each year put patients at needless risk for allergic reactions or the sometimes deadly diarrhea, clostridium difficile.

The researchers also estimated the rate of inappropriate antibiotic use in adults and children by age and diagnosis. These data will help inform efforts to improve antibiotic prescribing over the next five years.

‘Antibiotics are life-saving drugs, and if we continue down the road of inappropriate use we’ll lose the most powerful tool we have to fight life-threatening infections,’ said CDC Director Tom Frieden, MD, MPH.

‘Losing these antibiotics would undermine our ability to treat patients with deadly infections, cancer, provide organ transplants, and save victims of burns and trauma.’

In 2015, the White House released The National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB), which set a goal of reducing inappropriate outpatient antibiotic use by at least half by 2020. This means that 15 per cent of antibiotic prescriptions (or half of the 30 per cent that are unnecessary) must be eliminated by 2020 to meet the CARB goal.

As part of the effort to achieve the national goal, CDC researchers analysed the 2010–2011 National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) to determine the number of outpatient visits resulting in antibiotic prescriptions by age, region, and diagnosis in the United States from 2010-2011. They found that:

  • Of the estimated 154 million prescriptions for antibiotics written in doctor’s offices and emergency departments each year, 30 per cent are unnecessary. This finding creates a benchmark for improving outpatient antibiotic prescribing and use
  • About 44 per cent of outpatient antibiotic prescriptions are written to treat patients with acute respiratory conditions, such as sinus infections, middle ear infections, pharyngitis, viral upper respiratory infections (i.e., the common cold), bronchitis, bronchiolitis, asthma, allergies, influenza, and pneumonia. An estimated half of these outpatient prescriptions are unnecessary

 

‘Setting a national target to reduce unnecessary antibiotic use in outpatient settings is a critical first step to improve antibiotic use and protect patients,’ said Lauri Hicks, DO, Director of the Office of Antibiotic Stewardship in the Division of Healthcare Quality Promotion, National Centre for Emerging and Zoonotic Infectious Diseases, CDC, and Commander in the US Public Health Service.

‘We must continue to work together across the entire healthcare continuum to make sure that antibiotics are prescribed only when needed, and when an antibiotic is needed that the right antibiotic, dose, and duration are selected.’