High rates of inappropriate antibiotic use continued despite a 15-year campaign by the Centers for Disease Control and Prevention (CDC) aimed at Michigan physicians and consumers on the dangers of antibiotic overuse.
The Center for Healthcare Research & Transformation (CHRT) released an issue brief detailing overall antibiotic prescribing for adult Blue Cross Blue Shield of Michigan (BCBSM) members. (The project is a non-profit partnership between the University of Michigan and BCBSM.)
While antibiotic prescribing in adults decreased 9.3% from 2007 to 2009, it increased 4.5% for children during the same time period. The studies found significant differences in prescribing patterns between rural southeast Michigan and the rest of the state, particularly for children. Children in rural southeastern Michigan were prescribed an average of .93 antibiotics per year, while elsewhere children were prescribed an average of 1.0 per year.
"The continuing high rate of antibiotic use for viral infections in children and adults—particularly outside of southeast Michigan—is of great concern, as is the increase in the use of broad spectrum antibiotics in children," said Marianne Udow-Phillips, CHRT’s director. "Using antibiotics when they are unnecessary—or treating simple infections with drugs that should be reserved for the most serious infections—are practices that contribute to antibiotic resistance, making future infections harder to treat."
Nearly half (49.1%) of antibiotic prescriptions in the study population were for broad spectrum antibiotics in 2009, compared to the national rate of 47%. Between 2007 and 2009, prescriptions for what the National Committee for Quality Assurance calls "antibiotics of concern" declined slightly in adults, decreasing 0.4% during that time period. In the same time period, antibiotics of concern prescribed to children increased 3.4%, from 44.9% to 46.4%.
One possible explanation for the rising rate in children is a rise in resistant pathogens in ear infections, according to the study brief. Other possible reasons are that kids get different infections than adults, and that some drugs that are used in adults are not used for pediatric patients.
Other highlights of the report are:
--BCBSM spent nearly $16.5 million for the top 10 antibiotics prescribed to adult members. Of these 10 most commonly prescribed drugs, five were antibiotics of concern. For pediatric members, three of the 10 most commonly were antibiotics of concern.
--Regions with higher overall antibiotic use rates for children also had higher percentages of antibiotics used for conditions with viral diagnoses.
--Geographic differences were more pronounced in the pediatric population, with the highest prescribing rates clustered in the Upper Peninsula, northern lower Michigan, and along the Ohio border.
"One factor that might explain this geographic difference is that there are fewer pediatricians in these largely rural areas, and relatively more children being seen by family practitioners," said Gary L. Freed, MD, MPH, chief of the Division of General Pediatrics at the University of Michigan. "The CDC's outreach efforts were focused on pediatricians, and in areas where there are more pediatricians, the antibiotic prescribing rate for pediatric patients is lower. This may indicate that the campaign did work as intended, and could be broadened to include other physicians."
According to the CDC, antibiotic-resistant infections in the U.S. create $20 billion in excess health care costs and 8 million additional hospital days.