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One in four antibiotic prescriptions are medically unnecessary, study finds

Amoxicillin penicillin antibiotics
REUTERS/Lucy Nicholson
Who’s to blame for the continuing overprescribing of antibiotics? A study published last year pointed to patients as well as doctors.

Almost 25 percent of the antibiotics prescribed in the United States to people covered by private insurance are inappropriate, according to a study published in the BMJ.

The study examined the insurance records for the year 2016 of more than 19 million privately insured U.S. children and adults (aged 18 to 64). About 7.6 million of those patients, or 40 percent, filled at least one antibiotic prescription that year.

The study then looked to see what those antibiotics were prescribed for. They found that in 23 percent of the cases, the drugs were not medically justified.

Most of the inappropriate antibiotics were given to patients for viral and other conditions that don’t respond to antibiotics, such as colds, chest infections and cough.


Another 36 percent of the antibiotics prescribed in the study were for conditions that only sometimes need such drugs, such as sinusitis. That suggests, say the study’s authors, that the proportion of unnecessary prescriptions was probably much higher than 23 percent.

“Despite decades of quality improvement and educational initiatives, providers are still writing antibiotic prescriptions for illnesses that would get better on their own,” said Dr. Kso-Ping Chua, the study’s lead author and a researcher at the University of Michigan, in a released statement.

An urgent health threat

These troubling findings underscore the magnitude — and seeming intractability — of what has become one of the world’s most urgent health threats: the development of antibiotic-resistant bacteria.

In the United States alone, more than 2 million people come down annually with an antibiotic-resistant infection, such as clostridium difficile, and at least 23,000 of them die, according to the Centers for Disease Control and Prevention (CDC).

The misuse of antibiotics — the prescribing of the drugs in medical situations where they are either ineffective or unnecessary — has been identified as a major factor behind the rise of those infections.

Who’s to blame for the continuing overprescribing of antibiotics? A study published last year pointed to patients as well as doctors. Many people tend to have a “why not take the risk?” attitude toward the drugs, even in situations where it’s known that the drugs aren’t indicated for the patient’s illness.


That attitude, however, overlooks the fact that these drugs are not benign — and not only because of their contribution to antibiotic resistance. Antibiotics have a long list of potential side effects, including diarrhea, stomach cramps, yeast infections and allergic reactions.

Sometimes those side effects can be quite serious. Last August, CDC researchers reported that adverse reactions to antibiotic drugs send about 70,000 children to U.S. hospital emergency departments each year.

What you can do

All of us need to be become better stewards of antibiotics and their use. We need to shed that “why not take a risk?” attitude.

To help us do that, the Choosing Wisely campaign has formulated five questions you should ask your doctor before you take antibiotics. These are questions you should ask yourself as well.

  • Do I really need antibiotics? Antibiotics fight bacterial infections, like strep throat, whooping cough and symptomatic bladder infections. But they don’t fight viruses —like common colds, flu, or most sore throats and sinus infections. Ask if you have a bacterial infection.
  • What are the risks? Antibiotics can cause diarrhea, vomiting, and more. They can also lead to “antibiotic resistance”— if you use antibiotics when you don’t need them, they may not work when you do need them.
  • Are there simpler, safer options? Sometimes all you need is rest and plenty of liquid. You can also ask about antibiotic ointments and drops for conditions like pink eye or swimmer’s ear.
  •  How much do they cost? Antibiotics are usually not expensive. But if you take them when you don’t need them, they may not work for you in the future — and that may cost you a lot of time and money.
  • How do I safely take antibiotics? If your doctor prescribes antibiotics, take them exactly as directed, even if you feel better.

FMI: You can read the BMJ study in full on the journal’s website.

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Comments (11)

  1. Submitted by RB Holbrook on 01/21/2019 - 10:05 am.

    A former employer of mine was convinced that antibiotics were the cure for whatever ailed you. Rather than agree to let someone go home or stay home with a bad cold or the flu, should would recommend that they “go to Urgent Care, and have them give you antibiotics.” She was convinced that antibiotics would work against viral infections, even when told that the medical consensus was that they did not.

    She bragged about dosing her daughter with amoxicillin “for maintenance.” I can only guess at what that did to the child’s immune system.

  2. Submitted by Pat Berg on 01/21/2019 - 10:55 am.

    I find it really disheartening that this is still a problem given all the public awareness of antibiotic resistance. I’m pleased that I have not experienced my own doctors pushing unneeded antibiotics when my illness doesn’t warrant it. I just wish more doctors were as conscientious as my own doctors have been.

  3. Submitted by Matt Haas on 01/21/2019 - 11:47 am.

    All the education in the world isn’t going to make a difference in a society where so many lack meaningful sick leave allowances at their employer. It’s easy to tell someone to drink plenty of fluids and rest, its not so easy for them to listen when missing their 10 hr shift tomorrow means they’re unemployed. Without meaningful sick leave legislative action, people will continue to seek a magic bullet, they have little other choice.

    • Submitted by Pat Berg on 01/21/2019 - 01:54 pm.

      The doctors own this. Sure, it would be nice if patients would quit asking for unnecessary antibiotics, but ultimately, it’s the doctors who are giving in and writing the prescriptions.

      • Submitted by Paul Yochim on 01/21/2019 - 02:30 pm.

        The doctors do not own it in its entirety. Unrealistic patient expectations and defensive medicine play a major role in this as well. Sadly patient satisfaction seems to carry more weight than outcome these days. There are organizations dedicated to tracking it. Doctors are pushed into a corner by these organizations including the Joint Commission. Reimbursement will become dependent on patient satisfaction scores.

        • Submitted by Pat Berg on 01/21/2019 - 03:51 pm.

          That sounds like part of the same overarching problem that has led to the opioid epidemic. If the system is prioritizing “patient satisfaction” over sound medical practice, that’s not right, either. Something else for our legislators to address?

          • Submitted by Paul Yochim on 01/21/2019 - 08:06 pm.

            Physicians need to address this themselves and keep the legislators out of it.

            • Submitted by Pat Berg on 01/22/2019 - 01:50 pm.

              I thought you said the doctors tend to overprescribe because they are answerable to organizations that are prioritizing patient satisfaction over sound medical practice. If that’s the case you’re making, it doesn’t sound like the doctors have much power to change things. Hence the reference to a legislative approach.

  4. Submitted by Ray Schoch on 01/21/2019 - 06:42 pm.

    I’m inclined toward Paul Yochum and Pat Berg. People who are sick often want a quick fix (I tend to like those, myself), and a few days of rest and rehab, while easy for an old retiree like me to accommodate, are basically out of the question for a lot of people who have no sick leave, no job security, and little alternative but to try to keep going. Indeed, while I like the idea of “patient satisfaction,” it has a serious downside in this context. Not every illness can be “fixed” by taking a pill or getting an injection.

  5. Submitted by Ray Schoch on 01/21/2019 - 06:45 pm.

    I’m inclined toward Paul Yochum and Pat Berg. People who are sick often want a quick fix (I tend to like those, myself), and a few days of rest and rehab, while easy for an old retiree like me to accommodate, are basically out of the question for a lot of people who have no sick leave, no job security, and little alternative but to try to keep going. Indeed, while I like the idea of “patient satisfaction,” it has a serious downside in this context. Not every illness can be “fixed” by taking a pill or getting an injection.

    Actually, I’m surprised it’s only about 25% overprescription. I’d have guessed 1/3 to 1/2. One interesting weirdness I’ve come across is the occasional parent who’s a dedicated anti-vaxxer, but has no problem, like the employer mentioned by RB Holbrook, pushing antibiotics on their children.

  6. Submitted by Bill Kahn on 01/23/2019 - 12:32 pm.

    One thing missing here is that any antibiotic wipes out the good with the bad resulting in some of the worst of the side effects and contributing to the epidemic of noncommunicable diseases described by Rodney Dietert in his book, “The Human Superorganism: How the Microbiome is Revolutionizing the Pursuit of a Healthy Life.” It can take a long time to get your natural flora and fauna back after a course of antibiotics, if you even can (might need a ‘transplant’), and that can and likely will adversely affect our health; so you darn well better need the ones you take.

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