Outpatient antibiotic use falling across the U.S.

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Outpatient antibiotic prescribing is annual between 2011 and 2018, according to a study of prescribing patterns in the United States’ largest integrated medical system, presented online at the European Conference on Clinical Microbiology and Infectious Diseases (ECCMID). It decreased by almost 4%. this year.

Veterans Affairs (VA) facilities play a major role in providing veterans care across the United States, providing care to more than 9 million veterans in more than 1,200 outpatient clinics.

Researchers speculate that the downward trend may be related to antibiotic management programs that have been widely implemented throughout the Veterans Health Administration’s (VHA) health system since 2014.

“We have seen positive steps taken to reduce antibiotic use in the Department of Veterans Affairs outpatient clinics, community-based outpatient clinics, emergency departments, and other outpatient settings. The medical team needs to congratulate the ongoing efforts to reduce unnecessary antibiotic use, “said the lead author. Dr. Haley Appaner, Providence VA Medical Center, Rhode Island, USA.

“But for over eight years, the three most commonly prescribed outpatient prescriptions Antibiotics— Almost unchanged. And even if the overall prescription is reduced Antibiotic resistance With the increase, there is still much work to be done. “

Over 2.8 million people in the United States Antibiotic resistant infection Occurs annually, killing at least 35,000 people and incurring $ 20 billion in medical costs. According to the WHO, as antibiotics become less effective, treatment of infectious diseases such as pneumonia, tuberculosis, sepsis, gonorrhea, and food poisoning becomes difficult and sometimes impossible.

Bacteria have long been thought to develop antibiotic resistance, primarily due to repeated exposure due to overprescription. Each year, 266 million courses of antibiotics are given to outpatients in the United States.

In 2011, VHA established the National Antibiotic Stewardship Task Force (ASTF) to support the implementation and development of antibiotic stewardship programs at VA, and in 2014 VHA established antibiotic stewardship programs in all hospitals. Requested introduction. Between 2008 and 2015, inpatient antibiotic use decreased significantly by 12%.

However, 80-90% of antibiotic use occurs outpatiently, and the US Centers for Disease Control and Prevention (CDC) does not require at least 30% of outpatient antibiotics (no antibiotics required) and up to 50%. I presume. Inappropriate prescription (unnecessary use and improper selection, dosing and duration).

To provide more evidence of prescribing patterns, researchers analyzed data from VA pharmacy datasets and antibiotics dispensed at VA outpatient clinics across the United States between 2011 and 2018. I investigated the tendency of prescription.

They calculated the annual treatment days (DOT) per 100 outpatient visits for all antibiotics, followed by the five most common antibiotics (doxycycline, azithromycin, amoxicillin / clavulanate, ciprofloxacin). Loxacin, and sulfamethoxazole / trimethoprim) were calculated separately. Over the eight years, the total number of antibiotic prescriptions dispensed in the community has decreased from 39.6 DOT / 100 visits in 2011 to 29.4 DOT / 100 visits in 2018, an average annual decrease of 3.9%.

The largest reduction was the use of the broad-spectrum antibiotic ciprofloxacin, which decreased by an estimated 12.6% annually. The authors point out that there was a national move away from the use of fluroquinolones such as ciprofloxacin when alternative agents were available due to the harm associated with their use, including Clostridium difficile. doing. infection, Drug adverse events, and resistance selection. Both the Department of Veterans Affairs and the Food and Drug Administration have issued safety warnings related to fluroquinolone, which are safer than others, including acute sinusitis, acute bronchitis, and uncomplicated urinary tract infections (UTIs). It is recommended to limit its use for uncomplicated infections with various treatment options.

The use of sulfamethoxazole / trimethoprim (commonly used for UTI) has also been significantly reduced (approximately 7% per year).

However, outpatient prescriptions have not changed: doxycycline (commonly used to treat skin and sexually transmitted infections), azithromycin (widely used for chest, nose and throat infections), and amoxicillin / Crablanate (especially used for widespread infections) was high. Respiratory) Between 2011 and 2018.

“The use of these three commonly prescribed antibiotics remains high and may be a good target for antibiotic management programs in VA to further reduce inappropriate outpatient prescriptions,” said Dr. Appaneal. I have. “If national guidelines take stewardship principles into account when making disease-specific recommendations, they may also help fight resistance. Use of antibiotics.. “

She continues. “Antibiotics are essential in the treatment of serious bacterial infections such as sepsis, pneumonia and meningitis, but acute respiratory diseases such as asthma, cough, earache and throat pain that do not respond to these drugs. Do not use antibiotics to treat meningitis .. Antibiotic resistance is not just a problem for clinicians. The general public also plays an important role in helping to preserve these important drugs. . “

The authors did not consider prescriptions prescribed outside the Department of Veterans Affairs system (such as local pharmacies) and may not have completed all outpatient settings, such as emergency department and outpatient surgery settings. It points out some limitations of the study, such as that. They also state that the generalization of the findings to the general population in the United States is limited because the study is primarily based on the elderly white male population.

Most women receive inappropriate treatment for urinary tract infections

Courtesy of the European Society of Clinical Microbiology and Infectious Diseases

Quote: Outpatient antibiotic use across the United States (July 9, 2021) obtained July 9, 2021 from did

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