A new study finds that, since 2000,
approximately 6 in 10 adults with sore
throat have been prescribed antibiotics, in
most cases unnecessarily.
Despite efforts to reduce rates of antibiotic
prescribing for adults with sore throats, a new
study finds that only minor improvements have
been made in recent years.
Previous research has found that the antibiotic
prescribing rate for adults visiting primary care
practices or the emergency department for a
sore throat decreased to approximately 70% in
1993. To calculate the antibiotic prescribing rate
since then, the current study, published online
on October 3, 2013, in JAMA Internal
Medicine , used data from the National
Ambulatory Medical Care Survey and the
National Hospital Ambulatory Medical Care
Survey. Both surveys are conducted annually,
are nationally representative, and collect
information on physicians and practices, patient
demographics, diagnoses, and prescriptions
written at ambulatory visits in the United States.
The researchers studied adults aged 18 and
older who visited a primary care physician or an
emergency department for a sore throat from
1997 to 2010. Patients with injuries,
immunosuppression, or additional infectious
diagnoses were excluded from the study.
Antibiotics given to patients were identified and
classified as penicillin, amoxicillin, erythromycin,
azithromycin, other second-line antibiotics, and
all other antibiotics.
A total of 8191 sore throat visits were included
in the study, representing an estimated 92
million visits nationally over the entire period
covered by the study. Sore throat visits
decreased from 7.5% of all primary care visits
in 1997 to 4.3% of visits in 2010. The portion
of emergency room visits that were for sore
throat did not change significantly during the
study period—it was 2.2% in 1997 and 2.3% in
2010. Antibiotic prescribing rates for adults with
sore throat dropped to 60% in 2000 and
remained stable from then until 2010. Although
the researchers did not have data to determine
whether a given prescription for antibiotics was
appropriate, they note that the portion of sore
throat patients who are prescribed antibiotics
continues to greatly exceed the 10% of adults
with sore throats who present with the only
common cause of sore throat requiring
antibiotics—group A Streptococcus infections.
Prescribing rates for penicillin, which is
inexpensive, well-tolerated, and recommended
to treat these infections, remained relatively
low, accounting for just 9% of antibiotics
prescribed during the study period. However,
prescription rates for more expensive, broader-
spectrum antibiotics increased. For example, in
1997 to 1998, prescription rates for
azithromycin were too low to be measured
accurately, but in 2009 to 2010, azithromycin
constituted 15% of antibiotics prescribed.
Despite the modest improvement in antibiotic
prescription rates for sore throat, the authors
warn that in cases in which they are unneeded,
antibiotics are likely to cause more problems
than they solve .
“Antibiotic prescribing to patients who are
unlikely to benefit is not benign,” the
researchers conclude. “All antibiotic prescribing
increases the prevalence of antibiotic-resistant
bacteria.”
approximately 6 in 10 adults with sore
throat have been prescribed antibiotics, in
most cases unnecessarily.
Despite efforts to reduce rates of antibiotic
prescribing for adults with sore throats, a new
study finds that only minor improvements have
been made in recent years.
Previous research has found that the antibiotic
prescribing rate for adults visiting primary care
practices or the emergency department for a
sore throat decreased to approximately 70% in
1993. To calculate the antibiotic prescribing rate
since then, the current study, published online
on October 3, 2013, in JAMA Internal
Medicine , used data from the National
Ambulatory Medical Care Survey and the
National Hospital Ambulatory Medical Care
Survey. Both surveys are conducted annually,
are nationally representative, and collect
information on physicians and practices, patient
demographics, diagnoses, and prescriptions
written at ambulatory visits in the United States.
The researchers studied adults aged 18 and
older who visited a primary care physician or an
emergency department for a sore throat from
1997 to 2010. Patients with injuries,
immunosuppression, or additional infectious
diagnoses were excluded from the study.
Antibiotics given to patients were identified and
classified as penicillin, amoxicillin, erythromycin,
azithromycin, other second-line antibiotics, and
all other antibiotics.
A total of 8191 sore throat visits were included
in the study, representing an estimated 92
million visits nationally over the entire period
covered by the study. Sore throat visits
decreased from 7.5% of all primary care visits
in 1997 to 4.3% of visits in 2010. The portion
of emergency room visits that were for sore
throat did not change significantly during the
study period—it was 2.2% in 1997 and 2.3% in
2010. Antibiotic prescribing rates for adults with
sore throat dropped to 60% in 2000 and
remained stable from then until 2010. Although
the researchers did not have data to determine
whether a given prescription for antibiotics was
appropriate, they note that the portion of sore
throat patients who are prescribed antibiotics
continues to greatly exceed the 10% of adults
with sore throats who present with the only
common cause of sore throat requiring
antibiotics—group A Streptococcus infections.
Prescribing rates for penicillin, which is
inexpensive, well-tolerated, and recommended
to treat these infections, remained relatively
low, accounting for just 9% of antibiotics
prescribed during the study period. However,
prescription rates for more expensive, broader-
spectrum antibiotics increased. For example, in
1997 to 1998, prescription rates for
azithromycin were too low to be measured
accurately, but in 2009 to 2010, azithromycin
constituted 15% of antibiotics prescribed.
Despite the modest improvement in antibiotic
prescription rates for sore throat, the authors
warn that in cases in which they are unneeded,
antibiotics are likely to cause more problems
than they solve .
“Antibiotic prescribing to patients who are
unlikely to benefit is not benign,” the
researchers conclude. “All antibiotic prescribing
increases the prevalence of antibiotic-resistant
bacteria.”
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