Just eight percent of antibiotic prescriptions in 2016 were clearly justified, according to a new study of privately-insured Americans.
The rest were dubious – 23 percent were unnecessary, 36 percent were possibly necessary, and 28 percent were made without a documented diagnosis.
In fact, according to the latest data in 2016, one in six adults and one in 10 children received an unnecessary prescription at least once.
Lead author Kao-Ping Chua of the University of Michigan warns this is likely a staggering underestimate of the true rate of over-prescribing which is driving us towards a future where antibiotics do not work against even the most minor of currently treatable pathogens.
Over-prescription of antibiotics is fueling superbugs, like untreatable gonorrhea (pictured)
WHAT YOU NEED TO KNOW ABOUT ANTIBIOTICS
WHAT THEY CAN BE USED FOR: Bacterial infections
Antibiotics kill bacteria, or stop them from replicating.
These are some examples of bacterial infections:
- Skin infections
- Strep throat
- Urinary tract / bladder / kidney infections
- Some sinus and ear infections
- Bacterial pneumonia
- Whooping cough
WHAT THEY CANNOT BE USE FOR: Viral infections
Antibiotics cannot kill viruses.
That means you should not take antibiotics for the flu, a cold, laryngitis, bronchitis, a runny nose, coughing up phlegm.
HOW TO TELL IF IT’S BACTERIAL OR VIRAL
It’s not always obvious.
Your doctor should do tests to determine which is which.
WHY YOU SHOULD ALWAYS FINISH THE ENTIRE COURSE OF DRUGS
Even when you’re feeling better, there may still be some bacteria in your body, which could then replicate and adapt to get around the antibiotics.
If you quickly relapse, it may be harder to treat.
‘Antibiotic resistance is one of the greatest threats to public health in the world, and the large number of antibiotics that providers prescribe to patients are a major driver of resistance,’ Dr Chua, a researcher and pediatrician at University of Michigan C.S. Mott Children’s Hospital and the U-M Institute for Healthcare Policy and Innovation, said.
‘Providers urgently need to eliminate prescribing that isn’t needed, both for the sake of their patients and society.’
Concerns about over-prescribing stoked up in recent years – but specifically pertaining to opioids, as the highly addictive painkillers started claiming lives (72,000 of them in 2017).
Opioids like Percocet, hydrocodone, oxycodone – or even heroin and fentanyl – are extremely addictive, and even small doses can be lethal.
To summarize a decades-long, complex saga: drug companies went unchecked as they pushed their products on medical providers, with lucrative incentives to prescribe more. What’s more, doctors knew that this powerful medication could provide instant relief for patients. By prescribing more, they could cut the risk of a patient being left helpless in excruciating pain out of hours.
Now, in the US, states are bringing lawsuits against drug companies, attempting to impose stricter restrictions on how doctors dish out drugs, and running public health campaigns to warn people about the dangers of opioids.
Antibiotics are not as immediately threatening – a high dose won’t kill you (unless you’re extremely allergic to penicillin and don’t get seen in time) and they’re not addictive (though some may include side effects of diarrhea, headaches and the like).
However, world health leaders have been warning for years that the over-prescription of antibiotics will be even more deadly than any addiction epidemic.
The more antibiotics are present in human bodies, the more pathogens become familiar with them.
Every time they confront antibiotics, they notice more things about the drug, adapting themselves to get around it.
That is why we are now seeing more and more ‘antibiotic-resistant superbugs’, which do not respond to the antibiotics we’ve always relied on to prevent needless deaths from things like tuberculosis and pneumonia.
The CDC estimates that two million Americans a year are affected by antibiotic-resistant infections, 23,000 of whom die.
According to Dr Chua, if over-prescribing continues the way it is now, that is set to rise.
His new study, published today in the British Medical Journal, found that the rate of antibiotic prescriptions is 805 per 1,000 people. National data suggest around 270 million antibiotic prescriptions are filled every year.
Using international medical coding guidelines, he and his team established whether a diagnosis ‘always,’ ‘sometimes,’ or ‘never’ justified antibiotics.
He was staggered by the findings.
He was also concerned by the high rate – more than a quarter – of prescriptions that had no documented diagnosis to go with them. Likely, he says, the prescription was done over the phone, with a long-time patient recounting some tell-tale symptoms of a bacterial infection, and a doctor ringing in a prescription just to nip it in the bud.
That is one of the myriad of reasons why curbing antibiotic prescriptions isn’t simple.
History has shown that taking an iron fist approach of punishment and reward for doctors is both inefficient and easily circumvented.
More importantly, it’s a two-way street: often it is the patients who come in demanding antibiotics.
For example, in Dr Chua’s field of pediatrics, antibiotics was once a standard treatment for pink eye (or, conjunctivitis), which is often a viral infection.
‘Patients come in and they expect or insist [on having antibiotics] because they have been exposed in similar situations in the past, perhaps inappropriately,’ he explains.
‘Now you’re trying to reverse that culture, which is an up hill battle.’
Researchers are trying creative ways to get around the problem.
One study, by some colleagues of Dr Chua’s in Michigan, sent out emails to doctors at one practice telling them they were either one of the best or one of the worst when it comes to over-prescribing. And since ‘doctors are competitive people’, as Dr Chua put it, they team did see a drop in over-prescription afterwards.
That could be a cheap and effective method.
But Dr Chua believes one immediate area of focus should be on how much healthcare centers rely on patient satisfaction.
In the US, patients – bunged up with a nasty cold, earache, headache, or what have you – have to pay to see a doctor. If you go out empty-handed, still ill, and down $40, you aren’t going to feel too great. Even a pointless prescription might soften the blow. And doctors know that. Often, they have just a few minutes to review the patient and get on to the next, so a promise of something – anything – is an easy tick.
That’s why Dr Chua wants to turn his sights next to prescription rates in other US populations.
His new study, which only covered privately-insured Americans, found that of the 3.6 million inappropriate antibiotic prescription fills, 71 percent were written in office-based settings, six percent in urgent care centers, and five percent in emergency departments.
He suspects that ratio may shift if we look at the larger proportion of Americans with public insurance, or no insurance, who more often go to urgent care for their ailments.
Either way, he says, more studies are needed, and more attention is needed to slow antibiotic resistance.
‘It’s increasingly clear that we can’t keep doing this,’ he says.
‘I’m pessimistic, we won’t get to zero [i.e., completely eliminating antibiotic over-prescription]. But we have to get as close as possible.
‘It’s very difficult to eliminate just because of all the incentives that providers face to prescribe.
‘But we need to keep working on it because those antibiotic resistant bacteria are causing more pain and suffering and we’re not developing new alternatives fast enough for the superbugs out there now. The antibiotics we use are going to become less and less effective.’