October 10, 2012

New Information on Where, When Antibiotics Are
Most Often Prescribed

Pittsburgh—If policy-makers understand when and where antibiotics are over-prescribed, perhaps they can do more to combat overuse.

That’s the assumption behind a new study of Medicare data that suggests wide variation in antibiotic prescribing for older patients based on geography and the season in which prescriptions were written.

Authors of the report, published online recently by the Archives of Internal Medicine, suggest, “Findings on variation in antibiotic prescribing can guide policy efforts to improve more targeted areas or specific therapeutic subclasses of antibiotics.”

“The overuse of antibiotics is common, and the consequences are clinically and financially substantial,” they add. “Not only can overuse lead to unnecessary spending for prescription drugs, but also it can increase the risk for adverse effects and population-level antimicrobial resistance.”

Researchers led by Yuting Zhang, PhD, of the University of Pittsburgh, looked at Medicare Part D data from 2007 through 2009 for about 1 million patients per year, comparing geographic variation in antibiotic use in 306 hospital referral regions, 50 states and the District of Columbia, and four national regions (South, West, Midwest, and Northeast). Quarterly change in antibiotic use also was reviewed across the four regions.

The South had the highest antibiotic use, with the West reporting the lowest, 21.4% of patients per quarter compared to 17.4%, respectively. Across all regions, the rate of antibiotic use was highest in the first quarter of the year—20.9% from January through March—and lowest during the third quarter: 16.9% in July through September.

“Overall, areas with high rates of antibiotic use may benefit from more targeted programs to reduce unnecessary antibiotic use,” the authors point out. “Although antibiotic use in the regions with lower use does not necessarily represent the clinically appropriate use given that overuse of antibiotics is common, quality improvement programs set attainable targets using the low-prescribing areas (i.e., the states in the West) as a reference.”

Overuse of antibiotics can be especially concerning for older Medicare beneficiaries, according to the researchers, who note, “Although older adults may have higher risk for adverse outcomes from infection, they may also be at particularly high risk for adverse outcomes from antibiotic use. Therefore, it might be necessary to target some quality improvement initiatives toward this age group.”

In an invited commentary, Ralph Gonzales, MD, MSPH, of the University of California San Francisco, and colleagues attribute the problem of antibiotic overuse to “a failure to translate national public health priorities and evidence into local practice and policies.”

“We need to find better ways to compel individuals and organizations to address the significance of the problem of antibiotic overuse and to increase the readiness for change and quality improvement of ambulatory practices in the United States,” they write.

U.S. Pharmacist Social Connect