Pew, CDC Release National Targets for Reducing Unnecessary Antibiotic Use

WASHINGTON—The Pew Charitable Trusts and the Centers for Disease Control and Prevention (CDC) released today a first-of-its kind analysis of antibiotic use in doctors’ offices, emergency rooms, and hospital-based clinics in the United States. The analysis, conducted in partnership with a panel of leading antibiotic use experts, identifies acute respiratory conditions as key drivers of antibiotic overuse in human health care and establishes data-driven targets for eliminating the approximately 47 million unnecessary antibiotic prescriptions issued in outpatient facilities across the country every year.

The findings are outlined in two documents released today: Pew’s report “Antibiotic Use in Outpatient Settings” and “Prevalence of Inappropriate Antibiotic Prescriptions Among U.S. Ambulatory Care Visits, 2010-2011,” an article authored by experts from Pew, CDC, and members of the panel, appearing in the current issue of the Journal of the American Medical Association. They outline the baseline analysis and condition-specific targets, as well as practical strategies to improve prescribing.

“This report provides the most in-depth picture to date of outpatient antibiotic prescriptions in the U.S. and will serve as a benchmark in measuring progress moving forward,” said David Hyun, M.D., a senior officer with Pew’s antibiotic resistance project, who focuses on research and policy development pertaining to the stewardship of antibiotics in health care settings. “While our estimates of unnecessary antibiotic use are conservative, it is clear that a small number of health conditions constitute the lion’s share of unwarranted antibiotic prescriptions in this country. These detailed data will help health care providers target stewardship efforts where they can do the most good.”

At least 30 percent of antibiotics prescribed in outpatient settings in the United States are unnecessary, according to the report. The majority are prescribed for acute respiratory conditions such as colds, sore throats, bronchitis, flu, and other viral illnesses that do not respond to antibiotics.

“The more antibiotics are used, the less effective they become. Reducing the needless use of antibiotics will slow the emergence of antibiotic-resistant microbes, so-called superbugs, which are among the most urgent public health threats of our time,” said Kathy Talkington, director of Pew’s antibiotic resistance project. “Patients and health care providers must work together to understand when antibiotics will help and when they won’t, and help preserve these lifesaving drugs for patients who really need them.”

Antibiotic use in outpatient settings represents the majority of dollars spent on antibiotics for human health care in the United States, and outpatient providers are often the first place patients go for health care when suffering from a cold, flu, sore throat, or other common condition for which antibiotics are often unnecessarily prescribed.

The analysis concludes that:

• Approximately 13 percent of all outpatient office visits in the United States, or about 154 million visits annually, result in an antibiotic prescription; about 30 percent of these prescriptions are unnecessary.
• Forty-four percent of outpatient antibiotic prescriptions are written to treat patients with acute respiratory conditions, such as sinus infections, middle ear infections, pharyngitis, viral upper respiratory infections (i.e., the common cold), bronchitis, bronchiolitis, asthma, allergies, influenza, and pneumonia. Half of these prescriptions are unnecessary.
• In 2015, the White House released a national action plan for combating antibiotic resistance, which included the goal of reducing inappropriate outpatient antibiotic use by 50 percent by 2020. Based on the panel’s estimate of unnecessary prescribing, this goal would be reached by reducing outpatient antibiotic use by 15 percent overall, which would result in approximately 23 million fewer antibiotics prescribed annually by 2020.

The panel outlined actions that health care providers, patients, and the health care industry as a whole can take to reach the targets, including:

• Individual outpatient health care providers can evaluate their own prescribing habits as well as implement stewardship activities in their practices.
• Health systems can provide expertise and resources to offices within their network to aid in stewardship implementation.
• Health plans can assist in data collection and analysis—evaluating the antibiotic prescribing habits of their providers and providing feedback that highlights potential areas for improvement.
• State and local health agencies can help provide outpatient facilities with information on best practices for implementing antibiotic stewardship programs, and help develop regional partnerships between various health care stakeholders, such as providers, health plans, and health systems, in order to better coordinate stewardship activities.
• Federal agencies can track antibiotic prescribing at the national level, identifying areas for further improvement and providing technical assistance to stakeholders interested in implementing stewardship efforts of their own.
• Organizations such as the National Committee for Quality Assurance that develop standards to assess the quality of health care services can establish metrics to assess the antibiotic prescribing habits of health care providers.
• Health care professional societies can provide expert guidance to their members on appropriate antibiotic prescribing and incorporating diagnostics to aid in prescribing decision-making.

“Prescribing unnecessary antibiotics is just one element of inappropriate use of antibiotics,” said Lauri Hicks, D.O., director of the CDC’s Office of Antibiotic Stewardship in the Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases. “Health care providers can also prescribe antibiotics at the wrong dose or for the wrong duration, amplifying the extent of inappropriate use. Setting a national target to reduce unnecessary antibiotic use is the first step, and we must work together across the health care continuum to reach this goal.”

Pew, CDC, and the expert panel are preparing a similar report on inpatient antibiotic prescribing. It will set national targets for reducing unnecessary use in hospitals and will be released in 2017.

The Pew Charitable Trusts is driven by the power of knowledge to solve today’s most challenging problems. Learn more at www.pewtrusts.org.