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The Five Most Over-Prescribed Antibiotics

Overuse in medicine and agriculture has led to slew of ‘superbugs’

The repercussions of antibiotic resistance were again underscored in a recent policy brief from Health Affairs and the Robert Wood Johnson Foundation.

The Centers for Disease Control and Prevention (CDC) has estimated that up to 50% of antibiotics are unnecessary or inappropriately prescribed. This overuse of antibiotics in medicine, as well as in agriculture, has led to a slew of so-called antibiotic-resistant “superbugs,” the brief points out.

When first-line and second-line antibiotic treatment options are limited by resistance or are unavailable, health care providers are forced to use antibiotics that may be less effective and more toxic and that may require more resources, such as longer hospital stays –– driving up both morbidity rates and health care costs.

Without new therapies to treat or prevent infections, the brief says, lifesaving procedures such as organ transplants, chemotherapy, dialysis, and caesarian sections will become more dangerous; and non-lifesaving surgeries, such as hip operations, that allow people to live active lives for a longer period and may enable them to stay in the workforce could theoretically become too risky to undertake at all.

Within health care settings and medical practices, efforts to stem antibiotic resistance have focused on more judicious prescribing policies and infection control, the brief says. In 2013, the CDC estimated that four out of five Americans are prescribed antibiotics each year. This partly results from physicians’ prescribing antibiotics defensively, even if their patients probably won’t benefit from them.

Options for curbing this practice have included incentive payments and feedback systems, but these programs can be expensive and have had limited success. One technique that has shown some promise is to educate patients about the proper use and prescription of antibiotics. A 2014 study found that a simply worded poster placed in examination rooms helped reduce unnecessary antibiotic prescriptions for respiratory infections during flu season by approximately 20%.

“Antibiotics are misused so often because of the belief that these are benign drugs and that patient satisfaction depends upon being prescribed an antibiotic,” Amesh Adalja, MD, a spokesperson for the Infectious Diseases Society of America, told Formulary Watch.

According to Adalja, the five most over-precribed antibiotics are:

Amoxicillin

  • Often prescribed for viral infections, such as acute bronchitis, mild ear infections, and viral pharyngitis.

Azithromycin

  • Often given incorrectly for viral infections, such as the common cold, sinus infections, and acute bronchitis.

Cephalexin

  • Overprescribed for skin conditions that may not require an antibiotic because they are noninfectious, will resolve on their own, or can be treated with topical antibiotics.

Ciprofloxacin

  • Often overprescribed for apparent urinary-tract infections (UTIs) that are not UTIs or when a simpler antibiotic, such as nitrofurantoin, would be sufficient.

Trimethoprim–Sulfamethoxazole (TMP/SMX)

  • Overprescribed for UTIs that may not be true infections since many elderly patients, for example, chronically have bacteria in their urine.
  • Also prescribed for skin boils, which usually don’t require antibiotics once they have been adequately drained.

Sources: Formulary Watch; May 27, 2015; and Health Affairs; May 21, 2015.

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