ANTIBIOTIC OVER-PRESCRIBERS IDENTIFIED

In the “CDC Tackles Antibiotic Resistance” blog, I mentioned over-prescribing of antibiotics by physicians as the underlying cause of antibiotic resistance. To review, antibiotic resistance occurs when a strain of bacteria changes its make-up, or produces a substance, that prevents an antibiotic from eradicating an infection caused by that strain. The bacterium becomes resistant to that antibiotic and the drug is no longer effective treatment. Overuse, or the inappropriate use, of antibiotics has led to this problem. 

The Centers for Control and Prevention (CDC) has looked into the antibiotic prescribing habits of physicians and found that 41% of all antibiotic prescriptions were written by only 10% of physicians; what the CDC calls “higher-volume antibiotic prescribers.” Data extracted from Medicare Part D beneficiaries showed that higher-volume prescribers wrote a median of 680 antibiotic prescriptions per 1000 patients, while normal, or lower-volume, prescribers had a median rate of 426 prescriptions per 1000 patients. Higher-volume prescribers wrote a median of 60% more antibiotic prescriptions than 90% of all prescribing physicians. 

Most patients receiving these prescriptions were age 65 and above, and prescribers were mostly from “states in the south.” Forty-eight percent of high volume prescribers practiced in southern states and wrote nearly half (49%) of the prescriptions in the region. Their median volume was 696 antibiotic prescriptions per 1000 patients. Family physicians and internists were the specialists most often classed as high-volume prescribers. That stands to reason because patients call their primary care physician first in situations of this kind.  

For literally decades, attempts have been made to educate physicians on the proper use of antibiotics to prevent the development of resistance. Physicians hear the message, but still bow to the demands of a misinformed public. When people perceive they need an antibiotic for their cold or cough, they shop around until they find a doctor who will prescribe it. Many times I told a patient their illness was viral and they didn’t need an antibiotic. Then three days later, when they were no better, I caved and prescribed one. It was almost like, “I’m not gonna get better just so I can show you I really did need an antibiotic!” I know that’s not true, but it sure seemed that way. 

Hospital and medical society therapeutics advisory committees have joined the educational effort by informing over-prescribers of the problem they are causing. In Canada, “a single letter (a communication) comparing the highest-prescribing primary care physicians prescribing habits to their peers, has led to reductions in antibiotic prescriptions and drug costs.” This is a “big brother is watching” moment because to find target prescribers requires some snooping into their confidential doctor-patient interactions. HIPAA law may be tested here, but anything in the name of medical research can skirt HIPAA regulations. 

Fortunately, most overprescribing of antibiotics is done by a small percentage of doctors. And fortunately, educational and punitive efforts are being made to reduce over prescribing and slow the development of antibiotic resistance. I know that as a lay person, you might think this subject doesn’t pertain to you, but it does. If you’re one whose wound is infected with MRSA (methicillin-resistant Staphylococcus aureus), or you have Clostridium difficile intestinal infection, you will have a completely different attitude. 

Reference: https.//jamanetwork.com/journals/JAMA-health-forum/full article/

Stephenson J. Study Identifies “Higher-Volume”Antibiotic Prescribers. JAMA Health Forum 2022;3(2):e220473.