Inappropriate antibiotic use in emergency rooms not decreasing in adults
An analysis of emergency room (ER)visits over a 10-year period finds that while inappropriate antibiotic use is decreasing in pediatric settings, it continues to remain a problem in adults, according to an article published ahead of print in Antimicrobial Agents and Chemotherapy.
In the study, the investigators mined data from the National Hospital Ambulatory Medical Care Survey for the years 2001-2010. During this time, acute respiratory tract infections accounted for 126 million visits to emergency departments in the US. In patients under the age of 19 they saw a decrease in the utilization of antibiotics for respiratory infections where they are not indicated. They saw no such reduction in adult patients.
"While emergency department antibiotic use for acute respiratory tract infections decreased in the past decade among children, we saw no decrease in antibiotic use for adults with acute respiratory tract infections," says coauthor John Baddley, of the University of Alabama at Birmingham, an author on the study. "Given organized efforts to emphasize antibiotic stewardship, we expected to see a decrease in emergency department antibiotic use for such infections."
That's very unfortunate, Baddley says, because the ER's see so many patients, since they are used not just for emergencies, but for primary care visits generally—especially among those who are uninsured or insured by Medicare. A major reduction in use of inappropriate antibiotics in the ER could have a big benefit just due to the large number of patients seen.
Acute respiratory tract infections, including rhinitis, sinusitis, and bronchitis, account for nearly one tenth of ambulatory care visits in the United States. While many of these infections are caused by viruses, clinicians still prescribe antibiotics for these conditions. Viruses are impervious to antibiotics, and inappropriate antibiotic use can lead to the development of antibiotic resistance.
"The observed lack of change in antibiotic utilization for adult acute respiratory tract infection patients, especially those with infections where antibiotics are not indicated, is concerning," the investigators write in the study. "This may indicate that efforts to curtail inappropriate antibiotic use have not been effective or have not yet been implemented for this subset of patients."
Complicating the picture, the investigators suggest that the lack of reduction in use of antibiotics in these cases may reflect, among other things, the difficulty of making definitive diagnoses, and the fact that patients frequently expect to receive an antibiotic, and pressure clinicians for them.