Unnecessary Antibiotic Prescribing Can Result in Costly Adverse Effects

A new Johns Hopkins study finds that one fifth of hospitalized adults experience adverse effects from prescribed antibiotics; one fifth of those effects occurred in patients who should not have been prescribed antibiotics in the first place.

Antibiotic resistance is a growing public health concern. In fact, the Centers for Disease Control and Prevention (CDC) estimate that at least 2 million Americans develop infections due to pathogens with developed resistance to available drugs, which results in a staggering 23,000 deaths each year. Although antibiotics have life-saving potential, when prescribed unnecessarily, they can do more harm than good.

A study coming in from Johns Hopkins found that not only does 1 in 5 adults suffer from adverse effects due to the antibiotics they are prescribed, but about a fifth of those effects occurred in patients who should not have received antibiotics in the first place.

The study, published in JAMA Internal Medicine, contributes to the wealth of evidence that “antibiotics are not benign,” according to a recent press release.

“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.” Pranita Tamma, MD, MHS, assistant professor of pediatrics and director of the Pediatric Antimicrobial Stewardship Program at The Johns Hopkins Hospital, explained in the press release.

According to the press release, oftentimes, healthcare practitioners are not weighing the risks and benefits of the antibiotics before they prescribe them to their patients. In a recent interview, Lauri A. Hicks, DO, Office of Antibiotic Stewardship, Centers for Disease Control and Prevention, delved deeper into the risks and benefits of prescribing. She said, “For many, many years, we’ve thought of antibiotics as the quick-fix to, pretty much, any infection. What we’ve learned over, over the years, is that there are actual severe consequences associated with treating antibiotics without respect.” She continued, “We really need to be taking antibiotic treatment more seriously. When we talk to our patients about antibiotics we really need to be communicating about both the risks and benefits.”

In the press release, Dr. Tamma stressed that every time healthcare practitioners want to prescribe an antibiotic, they should reflect on if the patient actually needs it. If they do, and a patient ends up experiencing antibiotic-associated adverse effects, she says, “that is, of course, unfortunate, we should be able to take comfort in knowing that at least the antibiotic was truly necessary.”

In the study, the researchers took a closer look at medical records of 1,488 adults who had been admitted to the Johns Hopkins Hospital between September 2013 and June 2014. Although the patients’ reasons for admittance were diverse, all records included in the study belonged to patients who had received “at least 24 hours of antibiotic treatment.”

The researchers sought to “determine the likelihood of an adverse reaction to antibiotics and to identify how many adverse reactions could be avoided by eliminating unnecessary antibiotic use.” Therefore, they kept tabs on patients for 30 days after they had been discharged from the hospital.

Their findings? Twenty percent of patients who had received antibiotics experienced at least 1 adverse effect. For “each additional 10 days of antibiotics,” the risk of experiencing adverse effects increased by 3%.

The researchers also wanted to see if the patients would go on to develop Clostridium difficile infection or multidrug-resistant infections; to do this, they continued to follow the patients for up to 90 days. They found that 4% of patients developed C. difficile and 6% of patients developed multidrug-resistant infections. No deaths were associated with any antibiotic-associated adverse side effects, but the researchers noted that 24% of patients had prolonged hospital stays, 3% of the patients had additional hospital admissions, and over half (61%) of the patients needed to receive “additional diagnostic tests.”

Furthermore, the researchers found that 19% of the antibiotics that had been prescribed to these patients were unnecessary, that means that “two reviewing infectious disease experts found no indication of bacterial infections in these patients.”

The researchers note that these numbers pertaining to antibiotic-associated adverse events might actually be an underestimation due to the fact that the Johns Hopkins Hospital has a strong antibiotic stewardship program, where other healthcare facilities may not.

The researchers hope that their findings will promote awareness among healthcare practitioners so that they can be more cognizant when it comes to their prescribing practices. Furthermore, Dr. Tamma hopes that these results will prompt patients to ask more questions regarding the antibiotics they are prescribed and the potential side effects that they may experience.

“That alone could reduce a large portion of unnecessary antibiotic prescribing,” Dr. Tamma concluded.