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How does antibiotic prescribing differ in healthcare settings across the US?

A recent study published in JAMA Internal Medicine investigated antibiotic prescribing in urgent care centers, emergency departments, retail clinics, and medical offices.

Antibiotic overuse, the inappropriate and unnecessary prescription and use of antibiotics, has been associated with increased antibiotic resistance and worse health outcomes. Antibiotic resistance occurs when the infected patient can no longer use antibiotics to effectively control or kill bacterial growth. As a result, the bacteria continue to grow and the infection worsens, eventually resulting in death.

It is very important for healthcare professional and the general public to be wary of the risks associated with inappropriate antibiotic use. Currently, in the United States, nearly 60% of antibiotic prescriptions are dispensed in medical offices and emergency departments. The remainder 40% are prescribed at urgent care centers and retail clinics.

A retrospective study, published in JAMA Internal Medicine, aimed to compare antibiotic prescribing in urgent care centers, emergency departments, retail clinics, and medical offices. The data revealed that antibiotic prescription was linked to 39%, 36.4%, 13.8%, and 7.1% of total visits at urgent care centers, retail clinics, emergency departments, and medical offices, respectively.

Visits related to complications that do not require antibiotics (antibiotic-inappropriate diagnoses), including viral upper respiratory tract infections, bronchitis/bronchiolitis, asthma/allergies, were highest at retail clinics, followed by urgent care centers, medical offices, and emergency departments. Finally, among the visits for antibiotic-inappropriate diagnoses, antibiotic prescription was highest in urgent care centers, followed by emergency departments, medical offices, and retail clinics.

The current findings demonstrate that the highest percentages of unnecessary antibiotic prescriptions in the United States take place in urgent care centers and emergency departments.

Similar studies should be conducted in other countries, including Canada, to help identify the main sources of inappropriate antibiotic prescriptions. These sources of unnecessary antibiotic prescriptions could benefit substantially from intervention strategies that help physicians make better decisions regarding antibiotic prescribing. These efforts would ultimately help prevent the risk of antibiotic resistance in individual patients and the community at large.

Written by Haisam Shah, BSc

Reference: Palms, D. L., Hicks, L. A., Bartoces, M., Hersh, A. L., Zetts, R., Hyun, D. Y., & Fleming-Dutra, K. E. Comparison of Antibiotic Prescribing in Retail Clinics, Urgent Care Centers, Emergency Departments, and Traditional Ambulatory Care Settings in the United States. JAMA Internal Medicine.

Haisam Shah BSc
Haisam Shah BSc
Haisam is a first-year Masters student in the Department of Physiology at the University of Toronto. His research involves understanding the role of cardiac fibroblasts in the progressive development of cardiac fibrosis following a myocardial infarction. He graduated from McGill University with a Bachelors of Science – Honors in Pharmacology, where he had the opportunity of investigating potential combination therapies for Glioblastoma Multiforme.


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