Study finds disparities in improper antibiotic prescribing

Hands of elderly man taking pills
Hands of elderly man taking pills

lakshmiprasad S / iStock

A study to be presented at the upcoming European Congress of Clinical Microbiology & Infectious Diseases (ECCMID 2022) shows high rates of inappropriate antibiotic prescribing for older Americans, Blacks, and Hispanics.

The observational study, led by a team from the University of Texas at Austin College of Pharmacy and the University of Texas Health Sciences Center, San Antonio, analyzed oral antibiotic prescribing data from the US Centers for Disease Control and Prevention's (CDC's) National Ambulatory Medical Care Survey from 2009 through 2016, a period that covered more than 7 billion patient visits to doctor's offices, urgent care clinics, and hospital emergency departments.

The researchers then determined whether that prescribing was appropriate based in ICD-9 and ICD-10 diagnosis codes, and evaluated rates of overall and inappropriate antibiotic prescribing by race/ethnicity, age, and gender.

Higher inappropriate rates in older, Black patients

The analysis found that 11.3% of visits included a prescription for an oral antibiotic, with patients under 18 years (114.1 prescriptions per 1,000 patient visits), Black patients (122.2/1,000 patient visits), Hispanics (138.6/1,000 patient visits), and women (169.6/1,000 patient visits) having the highest antibiotic prescribing rates.

When the researchers broke down the data on inappropriate prescribing, they found that nearly three quarters of the antibiotic prescriptions (73.9%) written for patients 65 and older were inappropriate. They also found high rates of inappropriate antibiotic prescribing for Black patients (63.8%), Hispanic patients (57.5%), and men (57.7%).

The most common reasons for inappropriate antibiotic prescriptions were non-bacterial skin conditions, viral respiratory tract infections, and bronchitis.

The study authors say the high rates of inappropriate prescribing for Black and Hispanic patients are likely linked to socioeconomic and cultural factors.

"Our results suggest that Black and Hispanic/LatinX patients may be not be properly treated and are receiving antibiotic prescriptions even when not indicated," lead study author Eric Young, PhD, PharmD, said in an ECCMID press release.

"We know that physicians typically send patients home with antibiotics if they suspect their symptoms may lead to an infection. This practice becomes more common when patients are unlikely to return for a follow-up visit (i.e., no established care within a clinic or hospital system), which more frequently happens in minority populations."

Young and his colleagues say the high rates of inappropriate prescribing in older patients likely reflects their higher susceptibility to infections and infection-like symptoms.

Targeted outpatient stewardship

Whatever the reasons, the study provides more evidence that rates of inappropriate antibiotic prescribing in US outpatient settings may be even higher than previous studies have indicated. Among the most widely cited studies is a 2016 CDC study published in JAMA that found that about 30% of oral antibiotics prescribed in US outpatient settings are not necessary.

But subsequent studies have found rates higher than 40%, and this new study indicates that inappropriate prescribing is even higher in certain demographic groups. That suggests US outpatient antibiotic stewardship efforts have a long way to go.

"Our results underscore that strategies to reduce inappropriate prescribing must be tailored for outpatient settings," Young said.

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