Prior studies of antibiotics suggest that one in 10 people taking them have some kind of adverse event, and that approximately 50% of antibiotic prescriptions for upper respiratory tract infections are unnecessary.
Now, researchers at Intermountain Health and Stanford University have shown that almost one in 1,000 antibiotic prescriptions for upper respiratory infections cause severe adverse events that require a follow up visit or even hospitalization. With tens of millions of unnecessary antibiotics prescriptions every year for these infections, there is a lot of patient harm that's avoidable, according to the study.
Dr. Harris Carmichael, lead author of the study, published April in the Journal of Internal Medicine, said that adverse events include severe diarrhea that may require hospitalization and IV fluid replacement, or even life-threatening secondary infections from the bacteria Clostridium difficile.
“When you take an antibiotic, what can happen is that it suppresses most of the normal bacteria makeup of your gut. And then this one particularly bad bacteria can overtake the gut, and that's called Clostridium difficile. And that infection is very hard to get rid of. Treatment courses are generally long," Carmichael said. "Its most severe form has a high mortality."
Carmichael and his colleagues used the Optum’s Clinformatics dataset to analyze 50 million unique patient insurance claims. He said his team focused on encounters where the patient came in for an upper respiratory infection, because a percentage of upper respiratory infections are viral and are not responsive to antibiotics.
“And so, we've learned two things in sort of relatively recent history. One is that antibiotics aren't always appropriate, even when you do have signs of an infection. And two, we’re increasingly having more severe adverse events, even when they are appropriate,” Carmichael said.
Carmichael said the results of this study call for an adjustment of expectations by the provider and the patient. He said that patients should understand that doctors are not being dismissive when they don’t prescribe antibiotics for viral infections. Carmichael added that providers should know that prescribing antibiotics when they are not indicated has risks for the patient.
