Antibiotic Are Used Unnecessarily For Acute Bronchitis

Antibiotics are being inappropriately prescribed and misused throughout the United States, according to experts at the Centers for Disease Control and Prevention (CDC). Published in the journal AJMC, the new study discusses the prevalence of antibiotics use among outpatients, specifically those using a commercial health plan. It concludes that the misuse of antibiotics tops the list of why antibiotic resistance is growing.

Authored by Rebecca Roberts, Lauri Hicks and Monina Bartoces, who are health experts at the “Get Smart: Know When Antibiotics Work Program (CDC)”, the paper showed that most health plans were not adequately avoiding the use of antibiotics in the management of acute bronchitis. In fact, antibiotics are prescribed as much as 80% of the times for bronchitis in adults when they are clearly not indicated for the condition.

The primary objective of the research was to assess the health plan performance against three measures of Healthcare Effectiveness Data and Information Set (HEDIS) tool.

These included ‘Appropriate Testing for Children with Pharyngitis’, ‘Appropriate Treatment for Children with Upper Respiratory Infections’ and ‘Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis’. Their analysis revealed that the third measure was inadequately addressed in most health plans, especially those available towards the south of the country. In simple words, adults were wrongly prescribed antibiotics.

The world is presently facing a rampant and irresponsible use of antibiotics, with one in four people reporting that they would use antibiotics from a previous prescription themselves if they felt they were facing the condition again.

A study in the journal Antimicrobial Agents and Chemotherapy exposed the antibiotic resistance rates to be high in populations which frequently used non-prescribed antibiotics. Barbara Taunter, one of the authors of the above mentioned Antimicrobial Agents and Chemotherapy article, informed US News: “We may lose the effectiveness of antibiotics if continued indiscriminate use occurs.”

Inappropriate use and prescription of antibiotics is the biggest reason of antibiotic resistance in the world. The CDC states: “More than two million people are infected with antibiotic-resistant organisms, resulting in approximately 23,000 deaths annually.”

Of all the conditions, antibiotics are mostly being (inappropriately) used for acute respiratory infections, such as bronchitis, sinusitis and pharyngitis. This misuse is the reason why antibiotics, once dubbed the magic bullets, are no longer effective.

Aside from being ineffective, antibiotics are the number one cause of adverse drug events (ADEs) in children. Out of the top 15 drugs causing ADEs and leading to emergency visits in children, antibiotics stand at solid 7. In adults, ADEs lead to 1 out of 5 ADE-related visits to the ER.

A CDC study says, “Prescribing antibiotics has increasingly become an issue related to patient safety and quality of care.” Therefore, to curb their use, HEDIS included the above mentioned measures when grading health plan’s effectiveness.

Such staggering figures are not only scary, they call for a quick and unswerving solution. One of such programs is called Antibiotic Stewardship Program. Such programs mainly aim to improve patient care while promoting a reduced antibiotic use. In 2014, the CDC directed all adult healthcare hospitals to have this program.

The recent CDC research revealed interesting geographical findings with respect to antibiotic-use distribution. They found that the New England Division had the greatest rate of antibiotics use in cases of bronchitis; their HEDIS percentage amounted to 21.9%. The condition for the rest of the country is also comparable with the Pacific Division being in the best condition, at 29.7%.

The AJMC article used the HEDIS assessment from the years 2008 till 2012. But the study could not get the data for every health plan in each year. Additionally, several health plans did not run the HEDIS tool for the measures relevant in the study, so the actual results may be skewed form the current outcome.

In the year 2014, President Obama issued an Executive Order which initialed the National Strategy for Combating Antibiotic-Resistant Bacteria. The primary purpose of the organization is to reduce deaths caused by antibiotic resistant bacteria by stopping emergence of resistance strains. Secondly, the president declared fighting resistant strains as a matter of National Security, thereby directing collaboration between different state departments to develop and implement the defensive strategies.

Among other measures, the most important issued by the President was the establishment of a task force. The task force would oversee the implications of the defensive strategies. In 2015, the task force came up with a National Action Plan that outlined their course of action.

The recent findings demand an increased focus and effort to address the threat that threatens millions of people worldwide. What we need are prompt actions and undivided attention to improve prescribing practices in the outpatient settings.

Now that we know, through this study, where in the country antibiotics are being inappropriately prescribed, public health experts, clinicians, healthcare providers and health policymakers need to devise a policy to overcome the gigantic threat and push antibiotic stewardship in the right direction.

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