The use of outpatient antibiotics is falling in the United States


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Outpatient antibiotic prescriptions fell nearly 4% annually between 2011 and 2018, according to a study on prescribing patterns in the largest integrated healthcare system in the United States, presented at the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID ) held online this year.

Veterans Affairs (VA) facilities play an important role in providing outpatient care in the United States, providing care to more than 9 million veterans in more than 1,200 outpatient clinics.

Researchers speculate that the downward trend may be related to antibiotic custody programs widely implemented throughout the Veterans Health Administration (HAV) health system since 2014.

“We have seen positive measures taken to reduce the use of antibiotics in VA outpatient clinics, community-based outpatient clinics, emergency services and other outpatient settings, and health care teams should be commended for their continued work to reduce l ‘unnecessary use of antibiotics,’ says lead author Dr. Haley Appaneal of Providence VA Medical Center, Rhode Island, USA.

“But for more than eight years, prescriptions for three of the most frequently prescribed outpatients “They haven’t changed much.” And even with this drop in general recipes, the threat of it increases, so much more remains to be done. “

In the US, more than 2.8 million each year, causing at least 35,000 deaths and $ 20 billion in health care costs. According to the WHO, infections such as pneumonia, tuberculosis, sepsis, gonorrhea, and foodborne illness are becoming increasingly difficult and sometimes impossible to treat, as antibiotics are less effective.

Bacteria have long been believed to develop antibiotic resistance largely due to repeated exposure through excessive prescription. Each year, 266 million courses of antibiotics are distributed to outpatients in the U.S.

In 2011, the HAV established the National Antimicrobial Stewardship Task Force (ASTF) to help guide the implementation and development of antibiotic custody programs in the AV, and in 2014, the HAV required that all of its hospitals introduce antibiotic custody programs. Between 2008 and 2015, the use of hospitalized antibiotics decreased substantially by 12%.

However, 80-90% of antibiotic use occurs in the environment and the U.S. Centers for Disease Control and Prevention (CDC) estimates that at least 30% of outpatient antibiotics are not needed (no no antibiotics) and up to 50% inappropriate prescription (unnecessary use and inappropriate selection, dosage and duration).

To provide more evidence on prescribing patterns, the researchers analyzed data from VA pharmacy data sets to examine trends in antibiotic prescriptions dispensed at U.S. VA outpatient consultations between 2011-2018.

The annual number of therapy days (DOT) was calculated for each 100 outpatient consultations for all antibiotics and subsequently individually for the five most common antibiotics (doxycycline, azithromycin, amoxicillin / clavulanate, ciprofloxacin, and sulfamethoxazole / trimethoprim). ). Over eight years, the total antibiotic prescriptions dispensed to the community dropped an average of 3.9% annually, from DOT 39.6 / 100 visits in 2011 to DOT 29.4 / 100 visits in 2018.

The largest decline occurred in the use of the broad-spectrum antibiotic ciprofloxacin, which was reduced by approximately 12.6% on average per year. The authors note that there has been a national movement away from the use of fluroquinolones, such as ciprofloxacin, if there are alternative agents due to the damage associated with their use, including Clostridium difficile , adverse drug events and resistance selection. Both the VA and the Food and Drug Administration have issued safety warnings related to fluroquinolones and recommend restricting their use for uncomplicated infections that generally have other safer treatment options, such as acute sinusitis, acute bronchitis, and uncomplicated urinary tract infections (UTIs).

The use of sulfamethoxazole / trimethoprim (commonly used for UTIs) also decreased substantially (about 7% per year).

However, outpatient prescriptions remained unchanged and were elevated for doxycycline (commonly used to treat skin infections and sexually transmitted infections), azithromycin (widely used for breast infections). , nose and throat) and amoxicillin / clavulanate (used for wide-ranging respiratory infections) between 2011 and 2018.

“The use of these three commonly prescribed antibiotics remains high and may be a suitable target for AV antibiotic stewardship programs to further reduce the inappropriate prescription of outpatients,” says Dr. Appaneal. “It could also help combat resistance if national guidelines take into account custody principles when making disease-specific recommendations. . “

She continues: “Antibiotics are essential for treating serious bacterial infections such as sepsis, pneumonia and meningitis. But they should not be used to treat acute respiratory conditions such as asthma, cough, earache and sore throat, which “They do not respond to these drugs. Antibiotic resistance is not only an issue for clinicians, but the public also has a crucial role to play in helping to preserve these vital drugs.”

The authors point to several limitations of their study, including those that do not take into account prescriptions that are filled out of the VA system (such as community pharmacies) and that may not be complete in all outpatient settings, such as the outpatient service. ’emergencies or outpatient surgery. They also point out that the study was largely based on a white male population, so the generalization of the results to the general U.S. population is limited.

Most women receive inadequate treatment for urinary tract infections

Provided by the European Society of Clinical Microbiology and Infectious Diseases

Citation: The use of outpatient antibiotics in the United States (2021, July 9), retrieved July 9, 2021 at

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