Study: ‘No Clear Rationale’ for 45% of Medicaid Antibiotic Prescriptions


Millions of Medicaid patients are being prescribed antibiotics for no clear reason, according to a new study from Northwestern Medicine.

The numbers suggest efforts to prevent the rise of antibiotic-resistant bacteria could be undermined by inappropriate prescribing practices – with potentially disastrous consequences for public health.

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The study, released earlier this month, found that 45% of all Medicaid prescriptions for antibiotics were made without any clear rationale; 17% of patients were given antibiotics despite there being no documentation of an infection-related diagnosis; and 28% of prescriptions were written without any evidence of a visit to a doctor.

“Right out of the gate I would say that this isn’t something that should never happen but the degree to which it is happening is disturbing. It accounts for almost a third of all antibiotic prescriptions,” said senior study author Dr. Jeffrey Linder, chief of general internal medicine and geriatrics in the department of medicine at Northwestern University Feinberg School of Medicine. “Most of them are probably for respiratory symptoms and most of those respiratory symptoms are probably caused by viruses -- but there is no documentation around these antibiotic prescriptions at all.”

The new study evaluated 298 million prescriptions filled by 53 million Medicaid patients between 2004 and 2013.

Antibiotics are prescribed in the United States at a rate that is “double that in many other countries,” according to the study. And each year more than two million people in the U.S. are made sick and some 23,000 die from infections caused by antibiotic-resistant bacteria.

Linder noted that about 800 antibiotic prescriptions are written per 1,000 Americans compared to 600 in the U.K and only 325 per 1,000 in Sweden.

“The Swedes, despite just having about a third the rate of antibiotic prescriptions compared to Americans, are not dropping dead of infectious diseases,” said Linder. “So our rate of 800 is almost certainly way too high.”

“Indiscriminate use of antibiotics is increasing the prevalence of antibiotic-resistant bacteria and rendering them ineffective,” said Linder. “It’s concerning that nearly half of antibiotics are prescribed without a visit or without a clear rationale.”

The World Health Organization says that rising antibiotic resistance is one of the biggest threats to global health, food security and development.

Antibiotics are used to treat bacterial infections and to prevent infection that could arise from many common surgeries. But over prescription as well as the use of antibiotics in livestock production has led to the rise of antibiotic-resistant bacteria.

One key problem is that patients often expect and/or demand antibiotics from their doctors, said Linder.

“Without urgent action, we are heading for a post-antibiotic era, in which common infections and minor injuries can once again kill,” according to a 2018 report from the World Health Organization.

“While there are some new antibiotics in development, none of them are expected to be effective against the most dangerous forms of antibiotic-resistant bacteria,” the WHO says in the report. “Antibiotic resistance is putting the achievements of modern medicine at risk.”

Linder agreed and said the public should be “very concerned” because the development of new antibiotics cannot keep pace with the evolution of so-called superbugs.

“All of modern medicine relies on our use of antibiotics,” said Linder. “If you don’t have antibiotics you cannot do surgery. You cannot do organ transplantation. You cannot do chemotherapy. You need antibiotics to make those things work. And if we lose antibiotics these miracles of modern medicine become infeasible.”


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