OHA: Antibiotics still being mis-prescribed for viruses

Unnecessary use of antibiotics on viruses, which can lead to dangerous antibiotic resistance, is on the decline, state officials said Wednesday — but more work needs to be done to discourage inappropriate prescribing of these drugs for non-bacterial illnesses.

Overall, antibiotic prescriptions for oral medications used in outpatient settings have been steadily dropping in Oregon since 2008, when OHA first recruited Oregon health insurers to voluntarily provide data on their annual numbers of prescriptions.

Between 2008 and 2016, annual rates of prescriptions for oral antibiotics fell 32 percent, and a 5 percent drop was seen between 2015 and 2016, said Ann Thomas, MD, public health physician at the Oregon Health Authority Public Health Division.

But Oregon clinicians are still over-prescribing for some conditions such as bronchitis, which is due to a virus in a majority of cases and rarely requires antibiotics, said Thomas, medical director of OHA’s Alliance Working for Antibiotic Resistance Education (AWARE).

In 55 percent of bronchitis cases in Oregon in 2014, patients filled a prescription that likely was unnecessary. Worse still, 90 percent of the patients who filled an antibiotic prescription for bronchitis got a broad-spectrum drug, meaning that it attacks a wide range of different bacteria, increasing the risk of developing resistance among several types of bacteria.

“Broad-spectrum antibiotics are often used for infections that don’t require treatment in the first place, so it’s always perplexing to see them prescribed for conditions like bronchitis and the common cold,” Thomas said.

Nov. 13-19 is “U.S. Antibiotic Awareness Week,” an annual national observance to raise awareness of the threat of antibiotic resistance, and the importance of appropriate antibiotic prescribing and use. During the observance, AWARE reminds consumers about the dangers of unnecessary antibiotics for viral respiratory infections.

Antimicrobial resistance continues to pose serious health threats. At least 2 million people annually acquire serious infections–and 23,000 of them die–from antibiotic-resistant bacteria in the United States. Outpatient settings in the U.S. are home to more than 60 percent of national antibiotic-resistant expenditures. Respiratory conditions, including many where antibiotics are not appropriate, remain the most common diagnoses leading to antibiotic prescriptions in children and adults.

Oregon AWARE is providing educational materials and technical assistance to HealthInsight, Oregon’s Medicare quality improvement organization, as part of its Get Smart initiative to reduce inappropriate prescribing in clinics and other outpatient facilities in four states (the others are Utah, New Mexico and Nevada). In Oregon, about 200 facilities are participating and will use multiple quality improvement strategies to reduce prescribing.

“This is a critical time for providers and stakeholders to join together to preserve the power of antibiotics,” says Nicole O’Kane, PharmD, HealthInsight’s clinical director.

An information sheet with provider resources is available from HealthInsight at http://healthinsight.org/files/Outpatient%20Antibiotic%20Stewardship/Abx-Awareness-Week-2017-info-508.pdf.

When antibiotics are used for viral infections, such as colds and bronchitis, it can lead to resistant bacteria and dangerous side effects, such as diarrhea and vomiting, and they can be deadly if someone experiences an allergic reaction.

Consumers should avoiding asking their health care providers to prescribe antibiotics for colds and the flu, and question their provider if they really need antibiotics when prescribed. Consumers who receive appropriately prescribed antibiotics for bacterial infections, however, should take every dose, even if symptoms improve, since not doing so contributes to drug resistance. And they should not share antibiotics with others, since individuals taking antibiotics not prescribed to them can experience adverse reactions.

As part of its ongoing effort to reduce inappropriate use of antibiotics in Oregon, AWARE, funded by the Centers for Disease Control and Prevention, works to change Oregon clinicians’ prescribing habits.

To learn more about Oregon AWARE, visit the AWARE website at http://healthoregon.org/aware. For information about the CDC’s “U.S. Antibiotic Awareness Week,” visit the CDC at https://www.cdc.gov/antibiotic-use/week/index.html. The 2016 “Antibiotic Prescribing in Outpatient Settings in Oregon” report is available online at http://www.oregon.gov/oha/ph/DiseasesConditions/CommunicableDisease/AntibioticResistance/Documents/Oregon_Outpatient_Antibiotic_Prescribing_Report.pdf.