Blog | Friday, October 4, 2013

QD: News Every Day--Add antibiotics for sore throats to the 'less is more' list

A vast majority of people who see their doctors for sore throats or acute bronchitis receive antibiotics, yet only a small percentage should, a research letter found.

Researchers analyzed the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey and determined that doctors prescribed antibiotics in 60% of visits for sore throats when it should be closer to 10%, and 73% of visits for acute bronchitis when it should be nearly never.

The data were presented at a press conference at IDWeek 2013 and appeared online Oct. 3 in a Research Letter at JAMA Internal Medicine.

Researchers determined there were 94 million visits to primary care physicians and emergency rooms for sore throats between 1997 and 2010, based on an extrapolation of 8,191 visits. Physicians prescribed antibiotics at 60% of visits (95% CI, 57% to 63%), a decrease from 73% from numbers reported by the same authors in 2001. Penicillin prescribing remained stable at 9% of visits while azithromycin prescribing increased from below the threshold of reliable measurement in the 1997-1998 to 15% of visits in 2009-2010.

Also, researchers calculated there were 39 million visits to primary care physicians and emergency rooms for acute bronchitis between 1996 and 2010, based on an extrapolation of 3,667 actual visits. At the same time, there was a significant increase in the number of visits for acute bronchitis to primary care doctors, from 1.1 million in 1996 to 3.4 million in 2010. They also noted an increase in the antibiotic prescribing rate in the ED, from 69% to 73%, during the same 14-year period.

Also, the study in JAMA Internal Medicine reported that sore throat visits decreased from 7.5% of primary care visits in 1997 to 4.3% of visits in 2010 (P=0.006), while sore throat visits to the ED remained steady at 2.2% in 1997 and 2.3% in 2010 (P=0.18).

While antibiotic stewardship programs have helped reduce the misuse of the medications in hospitals, the analyses suggest that patients continue to request antibiotics and that doctors prescribe them, which contributes to drug resistance.

“Also, people need to understand that by taking antibiotics for viral infections, they’re putting something in their bodies that they don’t need,” said corresponding author Jeffrey A. Linder, MD, MPH, FACP, associate professor of medicine at Harvard Medical School, associate physician at Brigham & Women’s Hospital, Boston, and senior author of the study. “Taking antibiotics unnecessarily exposes people to adverse drug reactions, allergies, yeast infections and nausea, with no benefit.”