Antibiotics Prescribed in Outpatient Care Often Lack Documented Reason: Study

Despite known risks associated with overuse of antibiotics, which may lead to the development of antibiotic-resistant “superbugs” and other problems, new research suggests that doctors often prescribe the drug without a documented reason or for inappropriate purposes.

In a study published this month in the medical journal The BMJ, researchers found that more than 40% of all antibiotic prescriptions during outpatient doctor visits examined lack justification for the use of the drugs.

Researchers from Oregon State University evaluated data from the 2015 National Ambulatory Medical Care Survey, including nearly 991 million outpatient care visits nationwide. The data included visits to primary care doctors, urgent care centers, and emergency rooms.

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According to the findings, roughly 13% of the 991 million outpatient visits in 2015 resulted in an antibiotic prescription. Among the visits where antibiotics were prescribed, 57% of prescriptions, or 130.5 million prescriptions, were given for appropriate and approved uses.

However, 25% of prescriptions were given for inappropriate reasons, such as prescribing antibiotics for bronchitis or upper respiratory infections that are shown to not be treatable by antibiotics. Another 18% of prescriptions did not have a documented reason for being prescribed. When there is no reason documented in the patient file it is more likely the prescription was written without sufficient reason and wasn’t necessary at least some of the time.

Researchers determined this would result in 32 million inappropriate prescriptions and 24 million prescriptions given without a documented indication, indicating roughly 43% of all prescriptions in the study were prescribed unnecessarily.

Similar studies have also shown nearly half of all prescriptions are given without an infection diagnosis.

In the new study, being an adult male, spending more time with the doctor, having a chronic condition and seeing a specialist often resulted in more antibiotic prescriptions than the opposite conditions.

The findings also indicate 20% of adults ages 18-64 and 22% of adults over 65 received antibiotics without a documented indication compared to 8% of patients under 18 years old.

Sulfonamides and urinary anti-infective agents were the most likely to be prescribed without documentation.

“Antibiotic prescribing in the absence of a documented indication may severely bias national estimates of appropriate antibiotic use in this setting,” warned study authors. “This study identified a wide range of factors associated with antibiotic prescribing without a documented indication, which may be useful in directing initiatives aimed at supporting better documentation.”

Increased rates of C. diff infections and respiratory tract infections, as well as kidney stones and other ailments are linked to unnecessary antibiotic use.

Unnecessary antibiotics are also linked to the proliferation of drug resistant bacteria, or superbugs, that are untreatable.

The U.N. has warned superbug evolution is outpacing new antibiotic development, resulting in hundreds of thousands of deaths globally.


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