Among patients who visited urgent care centers for antibiotic-inappropriate respiratory problems like bronchitis, flu or asthma, nearly half (45.7%) were incorrectly prescribed antibiotics, according to a CDC-funded study analyzing 2014 data.
Incorrect prescribing was prevalent in other outpatient settings as well, including emergency departments (24.6% of cases) and traditional ambulatory care settings like medical offices (17%) and retail clinics (14.4%).
The results call into question the past finding that 30% of outpatient antibiotic prescriptions in the U.S. are unnecessary, equaling about 47 million prescriptions each year. Experts now think the number may be higher.
Public health officials have been sounding the alarm about antibiotic overuse and abuse for years and overprescribing is a major contributor to antibiotic resistance, resulting in resistant strains of bacteria known as superbugs.
The CDC study found substantial variability in prescribing practices across settings.
Antibiotics were prescribed in 39% of urgent care center visits, 36.4% of retail clinic visits, 13.8% of ED visits, and 7.1% of medical office visits in 2014. Patients sought care for respiratory problems not mitigable by antibiotics in 17% of retail visits, 16% of urgent care visits, 6% of medical office visits and 5% of ED visits.
This variability suggests “differences in case mix and evidence of antibiotic overuse, especially in urgent care centers,” according to the study’s authors.
Out of an estimated annual antibiotic prescription rate of 506 per 1,000 people in the U.S. in 2010, just 353 prescriptions were appropriate. That study also found that acute respiratory infections are the main source of inappropriate prescribing and the least likely to receive recommended treatment.
“Doctors often prescribe antibiotics even when they know they’re not indicated for many reasons,” said Katherine Fleming-Dutra, a medical epidemiologist with the office of antibiotic stewardship in the division of healthcare quality promotion at the CDC.
“One of the reasons we hear quite commonly is that doctors are worried about patient satisfaction and patient demand for antibiotics. Previous studies have shown that when doctors perceive the patient wants or expects an antibiotic, they’re more likely to prescribe an antibiotic," she said, adding that they may fear losing patients to competitors.
Although traditional medical offices and EDs still prescribe 60% of antibiotics in the U.S., a growing number of convenience care clinics (including urgent care centers and retail clinics) make up the remaining 40% of prescriptions.
The popularity of such clinics continues to climb in today’s quick-fix, instant gratification world. The first retail clinics opened around 2000, and by 2010 they numbered just over 1,300, according to RAND. By 2016, there were almost 2,800 — most being used by young adults, who account for 43% of patients.
The study’s findings highlight a problem amid this consistent market growth, but there are potential solutions. Antibiotic stewardship interventions are needed to reduce unnecessary antibiotic prescriptions across all settings, and now experts know to focus especially on urgent care centers in their reform efforts.
The National Action Plan for Combating Antibiotic-Resistant Bacteria, a CDC-compiled set of goals and outcomes, set a goal of reducing inappropriate antibiotic use by 50% by 2020, and antibiotic stewardship efforts are in place to further the initiative.
“We have seen some improvements,” Fleming-Dutra said. “In particular we’ve seen reductions in outpatient antibiotic prescribing from 2011 to 2015,” where the rates decreased by 4% overall. That was primarily driven by prescribing rates for children, which decreased by 13% in that time span.
Fleming-Dutra credited the decline to educational efforts, CDC and outpatient collaboration and the prevalence of vaccines that reduce diseases that could necessitate antibiotics later in life.