Urgent care clinics are a major source of unnecessary antibiotics, study finds

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According to a study published online this week in JAMA Internal Medicine, nearly half of all people diagnosed at an urgent care center with an upper respiratory viral infection, like the flu or the common cold, are given an antibiotic, even though antibiotics are neither recommended nor effective for such conditions.

In fact, according to researchers the Pew Charitable Trusts and the Centers for Disease Control and Prevention (CDC), the number of antibiotics prescribed inappropriately at urgent care centers for respiratory illnesses is two to three times higher than at other outpatient sites, such as doctors’ offices and hospital emergency rooms.

That’s a troubling finding, particularly given the rapidly rising number of urgent care clinics across the country (there are more than 10,000, according to a 2017 report).

In 2016, Pew and the CDC, already found that at least 30 percent of antibiotics prescribed in the U.S. are unnecessary. Most of those unneeded prescriptions — about 47 million each year — are given to patients with viral and other non-bacterial illnesses that don’t respond to antibiotics, including colds and the flu, and most coughs, sore throats and stuffy noses.

That study, however, looked only at antibiotics prescribed in doctors’ offices and hospital emergency departments.

Given the new findings about urgent care centers, it appears the percentage of inappropriate antibiotic prescriptions may be significantly higher.

Why it matters

The overprescribing of antibiotics is a major factor behind the rise of antibiotic-resistant infections, one of the most urgent threats to human health. Such infections, including clostridium difficile (CDIFF), carbapenem-resistant Enterobacteriaceae (CRE) and Neisseria gonorrhoeae, are responsible for more than 2 million illnesses — and at least 23,000 deaths — each year in the United States, according to the CDC.

Globally, antibiotic-resistant infections are implicated in at least 750,000 deaths per year.

The U.S. has been slow to reduce its inappropriate use of antibiotics — in part because both patients and doctors have a “why not take a risk?” attitude about the medications. That attitude appears to override concerns about the drugs’ potential side effects (which include diarrhea, yeast infections and sometimes quite serious allergic reactions), as well as broader worries about antibiotic-resistance “superbugs.”

People seem to think that they — or someone they care about — will not become one of those 2 million Americans who develop an antibiotic-resistant infection each year. 

Study details

For the current study, researchers used 2014 claims data from patients under the age of 65 with employer-sponsored health insurance. They looked to see how many unnecessary prescriptions for antibiotics (based on clinical guidelines) were given to these patients at urgent care centers, retail clinics (such as at drugstores), hospital emergency departments and doctors’ offices.  

Because acute respiratory infections — such as common colds, the flu and bronchitis — are the main source of inappropriate prescribing in outpatient settings, the researchers focused on patients with those illnesses.

They found that 45.7 percent of patients who visited urgent care centers for a respiratory illness that didn’t require an antibiotic were given a prescription for the drug. That compared to 24.6 percent of patients treated in emergency departments, 17 percent of patients who visited doctors’ offices, and 14.4 percent of patients who went to retail clinics.

The study did not look at why urgent care centers are prescribing more unnecessary antibiotics, but the authors of a commentary that accompanies the study offer a possible explanation: “Unlike patients seen at an outpatient practice, those who go to an urgent care center are unlikely to see their regular physician or a member of their physician’s team. Primary care physicians may be in a better position than an unfamiliar clinician to convince patients that it is not in their interest to take an antibiotic.”

Another factor — one involving economic incentives — may also be involved.

“Unfortunately, in urgent care and retail clinics, incentives may not be aligned to decrease antibiotic use,” the commentary’s authors write. “Patients may seek care in one of these clinics specifically because they desire antibiotics, and clinicians may worry that patients will not return to urgent care in the future if their expectations are not met.”

What you can do

You can help protect yourself, your family and your community from antibiotic resistance by following these recommendations from the CDC:

• Tell your healthcare professional you are concerned about antibiotic resistance.

• Ask your healthcare professional if there are steps you can take to feel better and get symptomatic relief without using antibiotics.

• Take the prescribed antibiotic exactly as your healthcare professional tells you.

• Safely throw away leftover medication.

• Ask your healthcare professional about vaccines recommended for you and your family to prevent infections that may require an antibiotic.

• Never skip doses.

• Never take an antibiotic for a viral infection like a cold or the flu.

• Never pressure your healthcare professional to prescribe an antibiotic.

• Never save antibiotics for the next time you get sick.

• Never take antibiotics prescribed for someone else.

FMI: The study and the accompanying commentary can be found on the JAMA Internal Medicine website.