New Study Emphasizes the Importance of Getting the Right Antibiotic

A new study from the CDC and the Pew Charitable Trusts shows that 52% of patients are receiving the wrong antibiotics for their sinus infections, middle ear infections, and pharyngitis.

There are well over 100 antibiotic medications on the market in the United States, and each one comes with recommendations for use on specific bacterial infections. Now, a new report shows that doctors are commonly giving patients prescriptions for the wrong antibiotics, an issue that negatively impacts patient care and contributes to the increasing problem of antibiotic resistance.

Earlier this year, a Centers for Disease Control and Prevention (CDC) study on the overuse of antibiotics found that about 1 in 3 antibiotic prescriptions given to patients is unnecessary in that it is prescribed to treat viral or other non-bacterial infections, which cannot be treated with antibiotics. Inappropriate antibiotic use is a major contributor to the growing problem of antibiotic-resistant bacteria currently plaguing the healthcare system, leading to an increased number of hospitalizations, deadly infections, and healthcare costs.

While 47 million unneeded antibiotic prescriptions are written each year, researchers at the CDC and the Pew Charitable Trusts examined not just the number of antibiotics, but which antibiotic medications are being prescribed for which infections. Researchers have studied the pairings of antibiotic drugs and bacterial pathogens to develop recommendations on the best treatment for each infection. Recent findings from the Pew and CDC study, published in the Journal of the American Medical Association, show that only 52% of the 44 million antibiotic prescriptions given for sinus infections, middle ear infections, and pharyngitis were for narrow-spectrum first-line drugs recommended based on the established guidelines. Nearly 30% of all antibiotics prescribed in doctors’ offices, hospitals, and other outpatient settings are for one of these three infections.

This study was based on US prescribing data from 2010 to 2011, which were analyzed by a panel of experts who found that instead of receiving prescriptions for the recommended first-line antibiotic, patients are too often receiving prescriptions for broad-spectrum antibiotics. “We need to continually remind providers to use the ‘right drug for the right bug’ in this day and age of increased resistance,” said Lauri Hicks, DO, one of the study’s authors and director of the CDC's Office of Antibiotic Stewardship. “Many common infections — and all of the ones included in this study - have clinical guidelines for prescribing the best antibiotic to the patient. And newer and broader does not necessarily equal better. Penicillin was the first drug discovered, and yet this class of antibiotics is still the most effective treatment for ear infections, bacterial sinusitis, and sore throats caused by strep.”

The study also found that children were more likely to receive the correct first-line antibiotic. For sinus infections, 52% of children received the recommended antibiotic, whereas only 37% of the right antibiotic were prescribed to adults. For pharyngitis, 60% of children received the right first-line antibiotic, as opposed to only 37% of adults. For middle-ear infections, which are uncommon in adults, 67% of children got the recommended first-line antibiotic.

“The finding that children were more likely to receive a first-line antibiotic is not surprising given that antibiotic prescribing to children overall has been shown to be lower than prescribing to adults for common upper respiratory conditions and we have seen more improvement in prescribing over the last 20 years for children than adults,” explains Dr. Hicks. “We believe this is due in large part to the emphasis on educating both pediatricians and parents about appropriate antibiotic use.” She notes that the CDC, the American Academy of Pediatrics, and others have focused on better antibiotic prescribing for children, and that the pediatric community has developed and promoted clear clinical guidelines for conditions such as common upper respiratory tract infections.

The panel of experts reviewing the data in this study set an overall target goal of 80% for correct antibiotic prescription, which, according to Dr. Hicks, is achievable through the education of doctors, nurse practitioners, physician assistants, and patients on the importance of appropriate antibiotic use. The CDC will be publishing its Core Elements of Outpatient Antibiotic Prescribing, with the hopes that it will become a valuable tool for clinicians and contribute to better antibiotic selection.