Study shows undue harm from over-prescribed antibiotics to patients leading to widespread side effects

When a patient requests or requires an antibiotic, even if it doesn’t work, the doctor is likely to give in and write a prescription, especially if they are working in a busy environment such as the clinic. emergency or urgent care.

However, a pivotal new study by researchers at Intermountain Health and Stanford University shows that over- and inappropriate antibiotic prescribing not only leads to antibiotic resistance—but also cause significant harm to the patient. This is one of the most comprehensive studies documenting the impact of antibiotic overuse in clinical practice.

Every year, enough outpatient antibiotics are prescribed in the United States to cover 80% of the population. The study, published in the journal Journal of Internal Medicineexamined 51 million patients over a 15-year period and focused on upper respiratory tract infections, where antibiotics were over-prescribed 50% of the time.

Researchers have found that some of the most dangerous antibiotics are rarely prescribed and commonly used, resulting in one in 300 patients experiencing side effects so severe that they need to see a doctor. doctor monitoring — or even hospitalization.

This study is one of the few large enough to estimate rare but serious side effects such as the potentially fatal diarrheal infection, Clostridium difficile. With previous studies showing 34 million unnecessary antibiotic prescriptions annually in the US, this means real harm to many patients and families.

“These findings highlight that improperly giving patients antibiotics is causing adverse effects,” said Harris Carmichael, MD, principal investigator of the study and a patient at Intermountain Health in Salt Lake City. real and widespread harm”. “Having these kinds of side effects for one in a few hundred, even a thousand patients doesn’t seem like much, but when you look at this at the population health level, we’re talking about hundreds of thousands of patients. adverse side effects. events are so severe that these patients require additional medical care.”

That means time away from work and school for family, unnecessary doctor visits, and the risk of serious infections that can last for months or years.

In the retrospective study, researchers from Intermountain and Stanford looked at insurance claims from the Clinical Data Marker Database.

Using data from Medicare Advantage and commercial insurance patients in all 50 states, inpatient and outpatient administrative claims, pharmaceutical claims, and patient demographics for beneficiaries as of December in 2002 through December 2017, they found 50.9 million claims for upper respiratory tract infections, including sinusitis, pharyngitis, laryngitis, bronchitis, and the common cold, representing 23 million patients.

The researchers then identified cases of patients who did and did not take oral antibiotics to treat upper respiratory tract infections, and if those patients were diagnosed with diarrhea, candidiasis, Clostridium difficile infection or a combination of the two. side Effects Later.

They found that 62.4% of upper respiratory cases infection patients filled out antibiotic prescriptions, consistent with previous studies of this population. After the initial visits, 26% of those patients had an outpatient follow-up visit within 14 days.

The proportion of patients diagnosed with side effects increased by 30% for those taking antibiotics. Side effects after taking antibiotics were found in 1 in 300 prescriptions, depending on the antibiotic prescribed, or 1 in 1,150 prescriptions overall.

“With millions of upper respiratory infections seen in the United States each year, the magnitude of these serious side effects is immense,” said Dr.

The researchers also found that the antibiotic Cefdinir was the fourth most commonly prescribed antibiotic for these patients, although it is rarely recommended under prescribing guidelines as an appropriate treatment. for simple diseases. upper respiratory tract infection.

This drug also has the second highest potential for side effects. That means patients are being prescribed a medication that is completely unnecessary or unlikely to be the most appropriate medication for their condition, says Dr. Carmichael.

He added that the likelihood of adverse events could be much higher, as these results only record follow-up visits when their adverse event is coded as such for insurance purposes.

That means the results do not include adverse events that the physician did not code for that particular side effect, nor for patients who were not sick enough to be seen in the doctor’s office but still had unnecessary additional recovery time.

Dr Carmichael said the findings point to an increasingly important need for antibiotic stewardship programmes, for doctors to follow prescribing guidelines and “prescribe antibiotics only when necessary”. , and it’s the right antibiotic for the right condition.”

When Intermenez implemented their own enhanced antibiotic management programs, including explaining to patients why they weren’t prescribed antibiotics if they asked for them, the health system fell by more than 15%. overall prescribing rate.

“Patients are not upset when they are not given antibiotics, as long as we take the time to explain their condition and that we are treating them in the best way,” said Dr Carmichael.

Provided by Intermountain Healthcare