Monday, December 11, 2017 by Russel Davis
A study published in JAMA Internal Medicine has revealed that doctors are dispensing unnecessary antibiotic prescriptions, and that one in five hospitalized adults suffer the side effects of this irresponsible practice. As part of the study, a team of researchers at the Johns Hopkins University School of Medicine examined the electronic medical records of nearly 1,500 adults admitted to the general medicine services at The Johns Hopkins Hospital between September 2013 and June 2014. The patients were hospitalized for various illnesses including trauma and chronic disease, all of whom received at least 24 hours of antibiotic treatment.
The experts then monitored the patients for 30 days following hospital discharge in order to check whether an adverse drug event (ADE) occurred and to determine the number of negative reactions that could have been prevented by eliminating unnecessary antibiotic use. The findings showed that up to 20 percent of patients who received antibiotic treatments suffered one or more adverse effects. Likewise, the researchers observed that the risk of ADEs increased by three percent for each additional 10 days of antibiotic treatment.
“Too often, clinicians prescribe antibiotics even if they have a low suspicion for a bacterial infection, thinking that even if antibiotics may not be necessary, they are probably not harmful. But that is not always the case. Antibiotics have the potential to cause real harm to patients. Each time we think to prescribe an antibiotic, we need to pause and ask ourselves, Does this patient really need an antibiotic? If the patient develops an antibiotic-associated adverse reaction, even though that is, of course, unfortunate, we should be able to take some comfort in knowing that at least the antibiotic was truly necessary,” says Dr. Pranita Tamma, director of the Pediatric Antimicrobial Stewardship Program at The Johns Hopkins Hospital.
The results also indicated that gastrointestinal reactions accounted for up to 42 percent of ADEs, while kidney and blood abnormalities made up 24 percent and 15 percent of ADEs, respectively. In addition, 24 percent of patients had prolonged admission following the onset of ADEs, while three percent required additional hospital admissions. Furthermore, nine percent of patients have had additional emergency department or clinic visits, while 61 percent required additional diagnostic tests.
“Although antibiotics may play a critical role when used appropriately, our findings underscore the importance of judicious antibiotic prescribing to reduce the harm that can result from antibiotic-associated ADEs,” the researchers conclude.
A Canadian study published in the Annals of Internal Medicine has also revealed that primary care physicians tend to over-prescribe antibiotic treatments for non-threatening diseases such as non-bacterial acute upper respiratory infections (AURI) among elderly patients. A team of researchers pooled data on 8,990 primary care physicians and more than 185,000 AURI patients aged 66 or older who visited a primary care physician in 2012 in Ontario. (Related: IRRESPONSIBLE: Doctors are prescribing antibiotics for the common cold.)
The researchers observed that up to 46 percent of patients with nonbacterial AURI received an antibiotic prescription, most of which were for broad-spectrum agents. Likewise, the findings showed that patients are more likely to receive prescriptions from mid- and late-career physicians compared with early-career physicians. The results also revealed that patients are more likely to obtain antibiotic prescriptions from doctors who saw 25 or more patients daily than those who saw fewer than 25 patients per day.
The study has received funding from the Ontario Ministry of Health and Long-term Care, Academic Medical Organization of Southwestern Ontario, Schulich School of Medicine and Dentistry, Western University and the Lawson Health Research Institute.