Who's Giving Inappropriate Antibiotics - Urgent Care, Retail, Emergency, or Medical Office?

Written by Clay Smith

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Urgent care (UC) centers wrote the most inappropriate antibiotic prescriptions for viral respiratory illnesses.  They were followed by the ED, medical offices, and finally by retail health clinics.

Why does this matter?
Antibiotic resistance is increasing.  In the US alone, the CDC estimates that 23,000 deaths are a result of antibiotic resistance.  Also antibiotics are not benign drugs.  The NNT for sinusitis is 18; the NNH is just 8.  In plain language, "18 participants will need to be treated with antibiotics for one extra patient to be cured more quickly. However, for every eight patients treated with antibiotics one patient experiences an adverse event caused by the treatment."

Who's writing for all those antibiotics?
This was a study of insurance claims and included outpatient visits to an urgent care center, retail clinic, hospital-based ED, or medical office.  The overall percentage of total visits that received an oral or parenteral antibiotic were: 39% of all urgent care (UC) visits; 36.4% of retail clinic (RC) visits; and 13.8% of ED visits.  Then they focused specifically on visits in which an antibiotic would be inappropriate: viral upper respiratory infection, bronchitis/bronchiolitis, asthma/allergy, influenza, nonsuppurative otitis media, and viral pneumonia.  They found that clinicians inappropriately prescribed antibiotics for these conditions most often in UC at 45.7%; followed by the ED at 24.6%; medical offices at 17.0%; retail clinics were the lowest at 14.4%.  The percentage of visits being prescribed an antibiotic sounds high.  But we need to consider the case mix of these venues for care.  Some, such as retail, have a high proportion of patients who legitimately need antibiotics.  But in all these settings, there was room for significant improvement in antimicrobial stewardship.

Source
Comparison of Antibiotic Prescribing in Retail Clinics, Urgent Care Centers, Emergency Departments, and Traditional Ambulatory Care Settings in the United States.  JAMA Intern Med. 2018 Jul 16. doi: 10.1001/jamainternmed.2018.1632. [Epub ahead of print]
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Reviewed by Thomas Davis

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