Broad-Spectrum Antibiotics Prescribed Too Often

Narrow-spectrum antibiotics such as amoxicillin are recommended as first-line treatment for otitis media, sinusitis, and pharyngitis, but a new survey of prescriptions shows that clinicians prescribe the recommended drugs only 52% of the time (95% confidence interval [CI], 49% - 55%).

"These findings indicate that the problem of inappropriate antibiotic prescribing includes not only prescriptions that are unnecessary altogether, but also selection of inappropriate agents," Adam L. Hersh, MD, PhD, from the Division of Pediatric Infectious Diseases at the University of Utah, Salt Lake City, and colleagues write. They report their findings in a research letter published online October 24 in JAMA Internal Medicine. The same team also published findings earlier this year that 30% of antibiotic prescriptions prescribed in outpatient settings may be unnecessary.

Guidelines from the American Academy of Pediatrics, the Infectious Diseases Society of America, and others recommend amoxicillin or penicillin as the first-line treatment for pharyngitis, and amoxicillin with or without clavulanate for otitis media and sinusitis. Clinicians should consider different antibiotics when first-line treatment fails or when the patient is allergic. The authors cite estimates that 10% of the population is allergic to penicillin and 10% of visits for sinusitis and otitis media are for failed first-line therapy. An important limitation of this study is that the team was not able to determine how often these factors were involved in their study sample.

On the basis of those previous estimates, they hypothesize that 80% of antibiotic prescriptions should be for the recommended antibiotics. Instead, prescribing rates for first-line drugs ranged from 37% (95% CI, 32% - 43%) for adults with sinusitis to 67% (95% CI, 63% - 71%) for pediatric patients with otitis media. Children received first-line antibiotics more often than adults, and the most common class of drugs prescribed, other than those recommended, was macrolides.

The prescribing data come from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, which cover office-based physicians and hospital outpatient and emergency departments.

Dr Hersh has received funding from the Centers for Disease Control and Prevention, the Agency for Healthcare Research and Quality, Pfizer/Joint Commission, and Merck. The other authors have disclosed no relevant financial relationships.

JAMA Intern Med. Published online October 24, 2016. Letter extract

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