As background information, the authors explained that antibiotics are commonly overprescribed, resulting in unnecessary extra spending as well as raising the risks of antimicrobial resistance and adverse effects. They commented that "Findings on variation in antibiotic prescribing can guide policy efforts to improve more targeted areas or specific therapeutic subclasses of antibiotics."
Yuting Zhang, Ph.D. and team gathered and assessed data from Medicare Part D from 2007 to the end of 2009. The information covered approximately 1 million people annually. Their aim was to determine whether antibiotic prescribing varied according to geographic location in older adults. Their data covered 306 hospital referral regions, 50 states plus the District of Columbia, and the regions of the South, West, Midwest and Northeast. Over the four regions, they also noted what the quarterly changes were in antibiotic use.
Below are some highlighted results from the study:
- The South has the highest rate, with 21.5% of patients being prescribed an antibiotic every quarter
- The West has the lowest rate, with 17.4% of patients being prescribed an antibiotic every quarter
- 19.2% of patients in the Midwest received an antibiotic prescription each quarter
- In all regions, antibiotic usage was the highest in the first three months of the year, and lowest during the third quarter
"Overall, areas with high rates of antibiotic use may benefit from more targeted programs to reduce unnecessary antibiotic use. Although antibiotic use in the regions with lower use does not necessarily represent the clinically appropriate use given that overuse of antibiotics is common, quality improvement programs set attainable targets using the low-prescribing areas (i.e. the states in the West) as a reference.
(Conclusion) Although older adults may have higher risk for adverse outcomes from infection, they may also be at particularly high risk for adverse outcomes from antibiotic use. Therefore, it might be necessary to target some quality improvement initiatives toward this age group."
Accompanying Commentary - Judicious Antibiotic Use in PracticeRalph Gonzales, M.D., M.S.P.H., of the University of California, San Francisco, and colleagues write:
"We believe that the persistence of antibiotic overuse in theUnited States is a failure to translate national public health priorities and evidence into local practice and policies.
We need to find better ways to compel individuals and organizations to address the significance of the problem of antibiotic overuse and to increase the readiness for change and quality improvement of ambulatory practices in the United States.
Strategies to achieve transformation at these levels may need to differ substantially from the current educational approaches that have been in use among patients and clinicians thus far."
What is the problem with overprescribing antibiotics?
- Costs - if any type of prescription drug is overprescribed, the costs either to the individual, the state (if there is universal health coverage), or the insurance companies are higher. Health care spending does not come from a bottomless pit of money; if one part becomes more expensive, either taxes must be raised, insurance premiums have to go up, or another part of the health service has to be cut back.
Side effects - antibiotics can cause some side effects. If more of them are being prescribed, the incidence of adverse events will also go up.
The following conditions are linked to antibiotic usage - diarrhea, feeling sick, being sick (vomiting), fungal infections in the digestive tract, vagina and mouth. More rarely, antibiotics have also been associated with a higher incidence of kidney stones (when taking sulphonamides), deafness (when taking erythromycin and the aminoglycosides), blood disorders (when taking trimethoprim), sunlight sensitivity (when taking tetracyclines), and abnormal blood clotting (when taking some cephalosporins).
Elderly patients may have inflamed bowels when on certain kinds of antibiotics, which often leads to serious diarrhea.
Antibiotic drug resistance - refers to types of harmful organisms - bacteria - which have developed resistance to available antibiotics. One example is MRSA, which stands for methicillin-resistant Staphylococcus aureus.
Staphylococcus aureus belongs to a group of bacteria which exist inside people's nose and on the surface of their skin. The bacterium is usually harmless - many of us carry it and are unaware. UK health authorities estimate that up to 30% of the country's population are carriers. MRSA can spread easily from human-to-human via physical contact.
If Staphylococcus aureus enters the human body through a wound or cut, then there is a serious risk of infection and complications. The majority of people's immune systems will fight off any Staphylococcus aureus infection. However, those whose immune systems are compromised (weakened), such as patients who have just undergone surgery, are vulnerable to serious and possibly life-threatening infections. For these people, Staphylococcus aureus infection may cause septic wounds, heart-valve problems, toxic shock syndrome, abscesses, impetigo, boils, and in extreme cases even death.
People with weakened immune systems infected with Staphylococcus aureus will need antibiotics. However, MRSA is resistant to many of them; this resistance is becoming progressively worse.
One of the causes of antibiotic resistance is the overuse of antibiotics. A percentage of patients do not complete their course of medication. In such cases, the targeted bacteria in their bodies are not killed off completely. The surviving bacteria build up resistance to the drugs (antibiotics) which were prescribed.
Some previously easily-treatable infections are alarming doctors. Scientists from the CDC (Centers for Disease Control and Prevention) in the USA reported in February 2012 that gonorrhea is becoming progressively more resistant to available antibiotics. They explained that "we may be facing a gonorrhea strain for which no current medications would be effective."
Written by Christian Nordqvist