Have you had a sinus infection recently? If so, there’s a good chance you received a non-recommended antibiotic prescription from your doctor, a new study in JAMA Internal Medicine shows.
In fact, just over half – or 52 percent – of patient visits for a sinus infection, sore throat or middle-ear infection resulted in recommended first-line antibiotics, according to the study, which was conducted by the Centers for Disease Control and Prevention and Pew Charitable Trusts.
For the study, researchers assessed the prescribing trends of providers in the doctor’s office or other outpatient settings, such as the emergency room, when facing one of these common bacterial infections, which account for about 44 million prescriptions each year.
What they discovered was that many prescriptions defied recommended guidelines, which often call for a drug treatment of penicillin or amoxicillin. Instead, many doctors opted for other treatments, most commonly prescribing a class of antibiotics known as macrolides.
Simply put, “… macrolides are not recommended for sinus or middle ear infections and are recommended for pharyngitis [sore throat] only for patients with an allergy to the penicillin class of antibiotics,” stated the Pew report.
“Increased antibiotic stewardship efforts are needed to reach the 80 percent target for use of first-line antibiotics.”
According to the study, non-adherence to recommended prescribing guidelines can not only lead to worse outcomes for the patient in most instances, but can also result in antibiotic overuse. This reduces the efficacy of the treatment over the long haul because it builds up resistance to the drugs unnecessarily.
“Prescribing antibiotics that target fewer types of bacteria can help to minimize the impact that antibiotic use has on the development of resistance,” the study’s authors explained.
Adults fared worse than children
Researchers found a range of prescribing best practices among the groups involved, which included both adults and children. Compliance with first-line antibiotics was highest for the pediatric population with middle-ear infections at 67 percent. Children with a sore throat were prescribed the recommended antibiotics 60 percent of the time.
For adults, the compliance levels were far worse. Among groups of adults with sinusitis and sore throat, both notched just a 37 percent compliance rate with recommended guidelines.
“Antibiotic selection for the treatment of adult patients (ages 20 and older) is in need of the greatest improvement,” said the report, which comes on the heels of an earlier report on antibiotic prescribing trends published in May 2016 showing that about 30 percent of all antibiotic doses – or some 47 million prescriptions – are unnecessary.
About 20 percent of the time, these bacterial infections don’t warrant the use of first-line antibiotics – when the patient is allergic or hasn’t responded to an initial round of treatment, for example – researchers noted. Yet the low rates of first-line use fail to correspond with the rare instances when their use isn’t directed.
To up compliance, researchers are recommending more education, in hopes that it will stem the tide of inaccurate dosing.
“Clinical decision support tools, such as clinical guidelines and decision flowcharts, can help clinicians make the most appropriate treatment decisions for individual patients,” the report suggested.
Richard Scott is a health care reporter focusing on health policy and public health. Richard keeps tabs on national health trends from his Philadelphia location and is an active member of the Association of Health Care Journalists.