1 in 3 antibiotic prescriptions are unnecessary

Fresh from JAMA:

In the United States in 2010-2011, there was an estimated annual antibiotic prescription rate per 1000 population of 506, but only an estimated 353 antibiotic prescriptions were likely appropriate, supporting the need for establishing a goal for outpatient antibiotic stewardship.

If 1 in 3 seems low to you (and it certainly does to me), that’s because it almost certainly is. The data were acquired from normal ambulatory care visits with physicians. Not included? Midlevels and urgent care centers (as well as dentists and over-the-phone call-ins). I bet it’s at least half taking all things into account.

The study’s lead author, Katherine Fleming-Dutra, quoted in the Washington Post (emphasis mine):

Clinicians are concerned about patient satisfaction and the patient demand for antibiotics. But the majority of individuals do trust their doctors to make the right diagnosis, and better communication by doctors about the dangers of antibiotic overuse can lead to more appropriate prescribing.

This is an important statement, but I’m not sure it’s true. For acute complaints, many people seek medical attention precisely because they want/feel/think they need antibiotics. Anything else they can get over the counter. Even if they are aware of the likelihood of a viral illness, many still want an antibiotic due to the possibility/notion of a superimposed infection or because they’re miserable and/or not getting better quickly. Even if the majority of individuals do trust their doctors, I would love to see data on the percentage of inappropriate antibiotic receivers that do!

Happy patients are good for business but often terrible for healthcare, and patient satisfaction is a dangerous quality metric.

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