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Excessive antibiotic use in flu season contributes to resistance

The cold and flu season is upon us — and with that comes the potential overuse of antibiotics. All too often, physicians prescribe antibiotics for viral infections, which typically is ineffectual and can even be dangerous for elderly Medicare patients.

An estimated 2 million Americans are infected with drug-resistant organisms each year, resulting in 23,000 deaths and more than $20 billion in excess costs, according to the Centers for Disease Control and Prevention.

Excessive antibiotic use in cold and flu season is not only costly, but it also contributes to antibiotic resistance, writes Marcella Alsan, MD, PhD, and her co-authors in a study published in the December edition of Medical Care. The study’s objective was to develop an index of excessive antibiotic use in cold and flu season and determine its correlation with other indicators of clinically appropriate or inappropriate prescribing.

Alsan, a core faculty member at Stanford Health Policy, and senior author, Dartmouth economist Jonathan Skinner, PhD, concluded that flu-related antibiotic use was correlated with prescribing high-risk medications to the elderly.

“These findings suggest that excessive antibiotic use reflects low-quality prescribing,” the authors wrote. “They imply that practice and policy solutions should go beyond narrow, antibiotic specific, approaches to encourage evidence-based prescribing for the elderly Medicare population.”

To better understand patterns of antibiotic overuse and whether such patterns reflect prescribing quality, the authors developed a measure that isolates antibiotic prescribing in response to state-by-state influenza activity. They focused on the elderly, as national data on antibiotic use are readily available and because the interactions between multiple prescriptions are particularly important for this population.

The index found that Mississippi and Florida had the greatest use of antibiotics in response to flu activity, with increases in antibiotic prescriptions for Medicare patients. Vermont and Connecticut were at the other end of the spectrum. The authors controlled for baseline differences across all states and for patient demographic characteristics.

The authors took this index of overprescribing antibiotics and correlated it with the good clinical practice of prescribing beta-blockers after a heart attack; as well as the often-erroneous practice of prescribing pain medications that can cause drowsiness or are contraindicated in the elderly Medicare population.

“We found that the tendency to use antibiotics inappropriately is part of a larger tendency to prescribe poorly,” Alsan said. “It’s not just about prescribing when unnecessary, but it’s also about failing to prescribe when indicated.”

Beth Duff-Brown is the communications manager at Stanford Health Policy. 

Previously: FDA changes regulation for antibiotic use in animals, Stanford med student/HHMI fellow investigates bacteriophage therapy as an alternative to antibiotics and The end of antibiotics? Researchers warn of critical shortages
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