Half of times Antibiotics prescribed without Diagnosis

A new of its kind study presented at IDWeek 2018 reports that clinicians prescribe antibiotics without an infection-related diagnosis nearly half of the time and one in five prescriptions were provided without an in-person visit.

Researchers found that of more than 500,000 antibiotic prescriptions they analyzed, nearly half were written without an infection-related diagnosis. And about 20 percent were given without an office visit -- usually over the phone.

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"We looked at all outpatient antibiotic prescribing and results suggest misuse of these drugs is a huge problem, no matter the symptom," said Jeffrey A. Linder, lead author of the study. "We found that nearly half the time, clinicians have either a bad reason for prescribing antibiotics or don't provide a reason at all. When you consider about 80 percent of antibiotics are prescribed on an outpatient basis, that's a concern."

Previous research has found antibiotics often are prescribed for certain symptoms (such as a sore throat or a cough) when they shouldn't be. Most of these types of illnesses are caused by viruses and therefore don't benefit from antibiotics, which only treat bacterial infections.

The study analyzed 509,534 outpatient antibiotic prescriptions given to 279,196 patients between November 2015 and October 2017. The researchers gathered these data from 2413 clinicians, including physicians, attending physicians, nurse practitioners, and physician assistants in specialty fields, at 514 health care clinics, according to the study.

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Researchers determined 46 percent of antibiotics were prescribed without an infection-related diagnosis: 29 percent noted something other than an infection diagnosis (such as high blood pressure or annual visit) and 17 percent were written without a diagnosis indicated. Of the 20 percent of antibiotics that were prescribed outside of an in-person visit, most were by phone (10 percent).

"Despite 40 years of randomized controlled trials showing antibiotics don't help for most coughs and sinus infections, many people are convinced they will not get better without an antibiotic and specifically call the doctor requesting one," said Dr. Linder. "At busy clinics, sadly the most efficient thing to do is just call in an antibiotic prescription. We need to dig into the data more, but we believe there is a lot of antibiotics prescribing for colds, the flu and non-specific symptoms such as just not feeling well, none of which are helped by antibiotics."