The Centers for Disease Control and Prevention (CDC) and the Pew Charitable Trusts announced yesterday that 12 national health organizations have signed on to an effort to cut outpatient antibiotic prescribing.
Antibiotic use in outpatient settings, which include emergency rooms and primary care offices, is the largest driver of antibiotic prescribing in the United States. According to research by a panel of experts convened by Pew and the CDC in 2015, about 154 million outpatient visits each year result in an antibiotic prescription, and at least 30% of those prescriptions are unnecessary. Their research was published in the Journal of the American Medical Association (JAMA) earlier this year.
To meet the goals of the White House's 2015 National Action Plan for Combating Antibiotic-Resistant Bacteria, which calls for cutting inappropriate outpatient antibiotic prescribing in half by 2020, that number would need to fall to 15%. The plan identifies misuse and overuse of antibiotics in healthcare and food production as the key factors in the development of antibiotic resistance.
No one-size-fits-all approach
In yesterday's joint statement, the groups vowed to help meet the White House's goal by expanding the current antibiotic stewardship efforts of their members, doing more research on programs that improve prescribing habits, and helping their members use antibiotics appropriately in outpatient settings.
"These coordinated efforts will help preserve these life-saving therapies for the good of all of our patients," the groups said in the statement.
A natural starting point for the effort would be reducing the use of antibiotics for acute respiratory infections such as sinus infections, bronchitis, and viral upper respiratory infections. According to the JAMA study, these conditions account for an estimated 44% of antibiotic prescriptions in outpatient settings, and half of those prescriptions are unnecessary, since many acute respiratory infections are viral in nature.
Outpatient antibiotic prescribing could also be reduced in the treatment of skin infections and acne. The panel convened by the CDC and Pew concluded that improving prescribing practices for these conditions could reduce antibiotic use by 13 million prescriptions annually.
The panel also concluded that while there is no one-size-fits-all approach, a number of stewardship strategies could help improve prescribing. One of those strategies is audit and feedback, in which the prescribing rates of individual doctors are compared to peer rates. Another strategy is training doctors to more effectively communicate treatment options to their patients, so that they're not simply telling patients that antibiotics aren't needed.
The 12 organizations joining the effort are the American Academy of Emergency Medicine, American Academy of Family Physicians, American Association of Nurse Practitioners, American Academy of Pediatrics, American Academy of Physician Assistants, American College of Physicians, American Medical Association, Infectious Diseases Society of America, National Association of Pediatric Nurse Practitioners, Pediatric Infectious Diseases Society, Society for Healthcare Epidemiology of America, and Society of Infectious Diseases Pharmacists.
See also:
Oct 5 joint statement on the importance of outpatient antibiotic stewardship
May 2016 Pew report on antibiotic use in outpatient settings
May 3 JAMA study
