A new study, published in Cambridge University Press, determined that around 28% of emergency department visits from 2016-2021 “resulted in inappropriate antibiotic prescribing.”
The study authors sought to take a recent accounting of antibiotic prescribing appropriateness in EDs, as “inappropriate outpatient antibiotic prescribing contributes to antimicrobial resistance.” They also sought to differentiate between why antibiotics were inappropriately prescribed, as sometimes they are associated with “diagnosis codes for infectious conditions that are plausible yet inappropriate indications for antibiotics,” and sometimes they are “associated only with diagnosis codes for conditions not plausible for antibiotics.”
The authors used the National Hospital Ambulatory Medical Care Survey (NHAMCS), which is a nationally representative survey conducted by CDC, for their data. Among visits from the sample, they found 2,698 diagnosis codes that they had determined “never” justified antibiotic use.
Of the visits with antibiotic prescriptions that they analyzed, “27.6% had inappropriate prescribing.” Of that percentage, 54% of the visits had a “plausible antibiotic indication” and 46% did not. The most frequent plausible indications were “potential signs and symptoms of infection (54.0%), bronchitis (17.4%), and URI (10.4%).” Among visits with no plausible indication, “the most frequent diagnosis codes were essential hypertension, chest pain, and joint pain.”
The authors of the study suggest stewardship initiatives focused on “safely minimizing unnecessary antibiotic prescribing with diagnostic uncertainty, such as using testing or scoring tools to determine the likelihood of actual bacterial infection.” Almost half of the ED visits lacked “plausible diagnosis codes,” which suggests that clinicians may have “prescribed antibiotics appropriately but neglected to code the condition, or alternatively, prescribed antibiotics for antibiotic-inappropriate conditions and deliberately avoided coding these to avert scrutiny.”
