Quality & Patient Safety

Study: Seasonal spikes in antibiotic misuse

Patient Safety Monitor, June 1, 2018

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 This March, a team of experts working with the Centers for Disease Control and Prevention (CDC) published a study on antibiotic prescription habits in outpatient facilities. The study, which appeared in the Infection Control & Hospital Epidemiology journal, showed that there are seasonal trends in prescriptions, with most antibiotics prescribed during winter months. 


The study also found that antibiotic misuse continues to be a problem, writing, “The lack of any apparent change in utilization over the course of this study may support the findings of other studies suggesting that professional guidelines may not be the most effective form of influencing provider actions.”

The study authors say their findings suggest that "current initiatives to improve the use of antibiotics in outpatient settings may not be enough to change clinicians’ prescribing practices." And they feel clinicians must be better equipped "with the tools and knowledge to know when antibiotics are needed."

"It is one of the most important steps towards reducing antibiotic-resistant bacteria, as well as adverse events associated with these powerful drugs,” the study's lead author, Michael Durkin, MD, MPH,assistant professor of medicine at Washington University School of Medicine, said in a statement released by the Society for Healthcare Epidemiology of America. “There has been progress in reducing antibiotic prescriptions in hospitals, but there needs to be more research and attention on how to address this issue in the outpatient setting.”

Unchanged rates
Durkin and co. conducted a retrospective analysis of 98 million outpatient antibiotic prescriptions from administrative claims data from 2013–2015, using a sample from Express Scripts Holding Company’s database of insured members. They tracked monthly prescription rates for all antibiotics, in addition to the five most commonly prescribed antibiotics:

  • Azithromycin
  • Amoxicillin
  • Amoxicillin/clavulanate
  • Ciprofloxacin
  • Cephalexin


Despite new professional guidelines, the study authors wrote there wasn’t any apparent change in the annual prescription rates. They added that their most conservative estimate found that 30% of those medications were inappropriately prescribed. 

“If quality improvement guidelines were sufficient to improve antibiotic prescribing practices, then we would have expected to see an overall decrease in antibiotic prescribing rates over time. However, standalone educational materials are rarely successful for changing clinician behavior,” wrote Durkin. “A more rigorous framework and greater investment of resources is needed to substantially improve outpatient antibiotic prescribing rates, helping to combat antibiotic resistance and improve patient safety.”

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Patient Safety Monitor.

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