Published: Oct 3, 2013

By Michael Smith

http://www.medpagetoday.com/MeetingCoverage/IDWeek/42052

AN FRANCISCO — Despite years of persuasion and publicity, antibiotics are still drastically overprescribed for two common complaints — sore throat and bronchitis, a researcher said here.

Analysis of two national ambulatory care databases suggests that doctors order antibiotics for about 60% of patients who complain of a sore throat, according toJeffrey Linder, MD, of Brigham and Women’s Hospital in Boston.

The problem is that only about one sore throat in 10 is caused by a pathogen — group A streptococcus — that responds to antimicrobial agents, he told reporters at the IDWeek meeting here.

“Clearly what we’ve done to now (to reduce inappropriate antibiotic use) is not causing change fast enough,” Linder said. That average represents a “painfully slow” change, he noted: In 1990, the rate was 80% and had fallen to about 70% in a snapshot in 2000.

“But it has been pretty much stable over the last 10 years,” Linder said.

The picture is even worse for bronchitis, Linder said — some 73% of complaints result in an antibiotic prescription, but the condition never responds to the drugs.

The research on sore throats is being presented here and online in JAMA Internal Medicine, while the bronchitis data was presented separately here.

The data come just weeks after the CDC warned that antibiotic resistance — fueled by inappropriate use of the drugs — is reaching a crisis.

Linder said it’s up to doctors to explain to patients the risks of inappropriate antibiotic use. “For individual patients, the compelling reason not to take antibiotics is they’re not going to help you and there’s a very real chance they’re going to hurt you,” he said.

For both analyses, Linder and a colleague looked at data from the annual National Ambulatory Medical Care Surveys and the National Hospital Ambulatory Medical Care Surveys. For sore throat, the surveys, from 1997 to 2010, included some 8,191 visits, which represent a national figure of some 92 million visits, Linder said.

And in six of every 10 visits over the study period, the physicians sent the patient home with a prescription for antibiotics — in many cases for antibiotics more expensive and less effective than penicillin, Linder said. (Group A streptococcus, he noted, is universally susceptible to penicillin, but in some cases has resistance to other drugs.)

There is a “shred of good news” in the data, Linder said. Sore throats as a proportion of primary care visits fell from 7.5% in 1997 to 4.3% in 2010 (P=0.006). “We’re a little hopeful that that represents patients being a little bit more selective about seeking care,” he said.

For bronchitis, the same databases showed that from 1996 through 2010, the average rate of antibiotic prescribing was 73% — with no significant change over time, Linder said.

And the estimated number of annual primary care visits for bronchitis rose from about 1.1 million in 1996 to 3.4 million in 2010, he added.

Despite the limited change, the findings show that “progress is being made,” commentedHelen Boucher, MD, of Tufts Medical Center in Boston, who speaks for the Infectious Diseases Society of America on antibiotic resistance.

But it’s at a “slower pace than we would like,” she told MedPage Today.

She noted that so-called antibiotic stewardship programs have been shown to reduce inappropriate prescribing in hospitals. “Our vision is that stewardship would be system-wide,” she said. For that to happen, she added, “it’s up to us to explain the downside of antibiotics.”