Study Finds Antibiotic Overuse Linked To Urgent Care Clinics

New research suggests that nearly half of urgent care patients leave with an antibiotic prescription, including many circumstances where use of the drugs is not needed. 

In a study published last week in the medical journal JAMA Internal Medicine, researchers with the U.S. Centers for Disease Control and Prevention (CDC) warn that the overuse of antibiotics at urgent care clinics may be contributing to the emergence and spread of drug-resistant bacteria.

According to the findings, about 40% of all antibiotics prescribed in the U.S. come from urgent care clinics, half the time for illnesses they are ineffective in treating, such as upper respiratory infections and bronchitis. Unnecessary use of antibiotics has been linked to a risk of so-called “super bug” infections, for which antibiotics may end up unable to treat.

Researchers analyzed data from the 2014 Truven Health Market Scan Commercial Claims and Encounters Database. This database captures claims from patients younger than 65 with employer sponsored insurance.

They also analyzed outpatient claims using facility codes to determine what type of facility the person was treated at, such as an urgent care center, retail clinic, hospital-based ER, or doctor’s office. Those were cross-referenced with data on antibiotic prescriptions identified using drug codes.

Researchers focused on antibiotic prescriptions for inappropriate uses, such as ailments that cannot be treated with antibiotics, like viral upper respiratory infections, bronchitis, asthma, allergies, influenza, ear infections, and viral pneumonia.

Health experts have long indicated using antibiotics to treat infections that are not treatable with antibiotics helps to spread antibiotic-resistant bacteria. For example, a 2015 study indicated treating bronchitis with antibiotics was ineffective because most cases of bronchitis are viral, not bacterial.

Data from the new study indicated 39% of patients who participated in urgent care visits were given antibiotic prescriptions. With 2.7 million urgent care visits in 2014, this amounts to more than 1 million patients across the country.

Among 4.8 million emergency room (ER) visits, about 15% received antibiotics, or more than 660,000 patients. Similarly, among about 60,000 retail clinic visits, 36% received antibiotics.

Of 148.5 million doctors office visits, 7% of patients got antibiotics, equaling more than 10 million prescriptions.

The study also indicated respiratory diagnoses that could not be treated with antibiotics accounted for nearly 20% of retail clinic visits. Among those visits, 14% resulted in inappropriate antibiotic prescribing for ailments like asthma or the flu.

The findings also found that 16% of respiratory diagnoses untreatable by antibiotics were seen in urgent care centers, 6% in doctors’ offices, and 5% of ER visits.

Among those, 46% of urgent care center visits, 25% of ER visits, 17% of doctor’s visits, and 14% of retail clinic visits involving respiratory ailments not treatable by antibiotics resulted in antibiotic prescriptions.

Rates involving inappropriate antibiotic prescribing from urgent care centers are three times higher than doctors office prescribing.

Antibiotic superbugs, such as hospital-acquired Clostridium difficile, have proliferated in recent years. Many point to the overuse of antibiotics as the source.

“These patterns suggest differences in case mix and evidence of antibiotic overuse, especially in urgent care centers. This finding is important because urgent care and retail clinic markets are growing,” the CDC researchers wrote. “Antibiotic stewardship interventions could help reduce unnecessary antibiotic prescriptions in all ambulatory care settings, and efforts targeting urgent care centers are urgently needed.”