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Nearly half of patients who go to emergency care to seek treatment for flu, colds, or other conditions that do not require antibiotics have been treated a prescription anyway. According to the results of a study published Monday, antibiotics are prescribed three times more often than antibiotics prescribed to patients with similar diseases.
Patients who receive unnecessary antibiotics run a risk of serious side effects even with a single dose of the drug, doctors say. The inappropriate use of these vital drugs also puts everyone at risk because overuse accelerates the emergence of resistant bacteria, or "superbugs", that can not be stopped with drugs.
An badysis published in the journal JAMA Internal Medicine is the first study of the prescription of antibiotics in the growing number of emergency care centers and retail health clinics, which serve annually as millions of patients in thousands of places in the United States. Retail clinics are integrated in grocery stores, big box stores and pharmacy chains. Emergency care clinics usually treat more serious injuries or illnesses that do not require an emergency visit.
Overuse of antibiotics is a huge and growing problem around the world. If nothing is done, according to a report from the United Kingdom, antibiotic-resistant bacteria could kill 10 million people each year by 2050, more than the number of people killed by cancer, for a cost of $ 100 trillion.
In the United States, nearly one-third of antibiotics – or about 47 million prescriptions issued each year – in medical offices, emergency rooms and hospital clinics are not necessary and inefficient, according to a 2016 study by the Centers for Disease Control and Prevention and the Pew Charitable Trust, the first to quantify the depth of the American problem.
This 2016 study did not contain information on a key health sector: urgent care centers and retail clinics, where an increasing number of patients
researchers CDC and Pew have tried to provide this information with the current study. They badyzed the insurance claims of a 2014 database of more than 156 million patient visits to emergency care centers, retail clinics, medical services, and healthcare providers. Hospital emergency and medical offices. The data show that emergency and retail clinics are "an unrecognized source of inappropriate prescription of antibiotics," according to an accompanying commentary entitled "Over-prescription in clinics of Emergency Care – The Fast and the Spurious. The comment was written by doctors Michael Incze, Rita Redberg, and Mitchell Katz, Inc. and Redberg are doctors at the University of California at San Francisco, and Katz is the executive director of the New York Public Health System. Researchers have focused on respiratory conditions that do not respond to antibiotics, such as colds, bronchitis, asthma, allergies, influenza and viral pneumonia. four per cent of visits for these conditions, which was almost three times higher than the 17% prescribed for inappropriate antibiotic diagnoses in traditional medical practices, and almost twice as high as those of emergency services, according to the study.
A surprise: retail clinics had the lowest rate for these inappropriate antibiotic diagnoses, 14 percent. Researchers have stated that the proper use of antibiotics is a goal of large retail pharmacy chains and could explain the lower percentage.
The new information suggests that the prescription of unnecessary antibiotics in the United States is greater than what researchers estimated two years ago. 19659002] "This will help us with an antibiotic stewardship strategy that does not just focus on doctors' offices and emergencies," said David Hyun, a leader of the Pew Antibiotic Resistance Project. One of the authors of the study. was limited by its reliance on diagnostic codes and commercial claims data instead of actual medical records. It does not include Medicare, Medicaid or uninsured patients, so it is not considered a nationally representative sample.
Still, "it's a snapshot of the real world that tells us we have a lot of work to do," said disease doctor at Tufts Medical Center in Boston who was not involved in the study. "Emergency care centers are growing by leaps and bounds in the age of consumption and people who want everything now."
Antibiotic-resistant bacteria have developed a capacity to resist drugs who should stop them. This is part of the broader problem of antimicrobial resistance, which includes antibiotics as well as drugs to fight against fungal, viral or parasitic infections. If these vital drugs are rendered ineffective by multidrug-resistant superbugs, even the most minor infections would be incurable, bringing back a level of danger never seen since the 19th century.
The rise of emergency care centers, an industry of $ 18 billion with over 8,000 locations were fueled by the convenience of opening hours in the evening and on weekends, the proximity and lower fees than a visit to the emergency room. But commentators have said that convenience may prompt "frequent visits for self-resolving diseases that would be best treated with management of rest and symptoms at home."
Antibiotic treatment rates may be more high unknown clinicians (instead of a primary care physician) may be less able to convince patients that taking unnecessary antibiotics is a bad idea, comment writers wrote
Some doctors Emergency physicians say that patients are looking for urgent care clinics
Patients have filed a complaint if they had not received a prescription for a "Z-pack", or l & # 39; Azithromycin, a widely used antibiotic, said Glenn Harnett, a physician and former chief medical officer. officer for a group of emergency care clinics operating in 23 states.
Clinicians and emergency homeowners worry about what they call "the Yelp effect," he said. If patients' expectations are not met, they could show less patient satisfaction and negative reviews on social media, which would affect clinic results.
Katherine Fleming-Dutra, deputy director of the CDC's Bureau of Antibiotic Management and another author study, says patients may be satisfied if doctors communicate effectively why antibiotics are not needed and what patients can do to to feel better. Like all medications, antibiotics can have serious side effects, destroying good bacteria and allowing bad bacteria to thrive,
The Urgent Care Association works with other industry stakeholders, the CDC and the Antibiotic Resistance Action Center of George Washington University. ways to ensure proper prescription of antibiotics. The groups held a two-day summit that ended Monday in Atlanta.
A major challenge is the management of patients' expectations. If a patient could enter a clinic and receive antibiotics last year, "and now you tell them" no ", this creates a disconnect in the patient's brain," said Laura Rogers, deputy director of the center for GW. 19659002] Laurel Stoimenoff, CEO of the Urgent Care Association, said that the industry is committed to ensuring the proper prescription of antibiotics and educating patients on the issue. because urgent care centers tend to treat more patients for conditions that lead to antibiotics, such as acute sinus infections.
