Wednesday, January 23, 2019

25% of Antibiotic Prescriptions Could Be Inappropriate

At least a quarter of outpatient antibiotic prescriptions filled in 2016 may have been unnecessary, researchers conclude in The BMJ.

Using a national U.S. claims database, the researchers identified over 15 million outpatient antibiotic prescriptions filled in 2016 by privately insured children and adults under age 65. The most common antibiotics used were azithromycin, amoxicillin, and amoxicillin-clavulanate, accounting for roughly half of prescriptions.

On the basis of ICD-10-CM diagnosis codes:
23% of prescriptions were classified as inappropriate, usually for acute bronchitis, acute upper respiratory tract infection, or respiratory symptoms.

36% were potentially appropriate, most frequently for acute sinusitis, acute suppurative otitis media, or acute pharyngitis.

13% were considered appropriate, most often for urinary tract infections, streptococcal pharyngitis or tonsillitis, and bacterial pneumonia.

Some 29% of antibiotic prescriptions did not have an associated diagnosis code.

The researchers note that many of the potentially appropriate prescriptions actually could have been inappropriate.

My Take:

If you read these stats, the percentage of antibiotic prescriptions that were inappropriate is undoubtedly much higher than 23%. The real number to look at is the 13% that were appropriate. Potentially, as much as 87% of the time antibiotics are prescribed inappropriately. The real number is someplace between 50 and 87%.

As much as 90% of upper respiratory infections (URI) are viral in origin and do not respond to antibiotic therapy. However, every day during the flu season, I see a patient that has been given antibiotics for the flu or the common cold. The short term side effects are generally vaginal yeast infections for the women and disruption of the microbiome for all. The long term effects are poorly understood but autoimmune disease is one possible outcome.

When you contract an acute URI that your system has been exposed to previously, the antibody blueprint is readily available. Your GALT (gut associated lymphoid system) relays the configuration of the infection to your thymus before it finds its’ way into your blood stream. The thymus stimulates antibody production and you recover in a couple of days.

If the infection is new to your immune system, it takes five days for antibody production to swing into action. This is the cold or flu that lays you low for a week.

Bottom Line:
Hold off on that antibiotic for five days if you suspect it may be viral in origin. Give your immune system a chance to mount a defense. If you are not beginning to improve after five days, then consider the antibiotic.

Take a good quality Echinacea product daily during flu season to help modulate your immune system. It is of little benefit once you contract the infection as it takes a full two weeks of supplementation to achieve the maximum benefit from this herb.

Source: January 17, 2019 NIH

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