Urgent care clinics overprescribe antibiotics

Urgent care prescribing

Almost half of people who go to walk-in clinics with symptoms of a cold or flu walk out with an antibiotic, according to a study released Monday by the Centers for Disease Control and Prevention and the Pew Charitable Trusts. Their previous analysis of outpatient prescribing, published in 2016, had looked at antibiotic prescribing in medical offices, emergency departments, and hospital clinics.

Patients who get unnecessary antibiotics are at risk for severe side effects, even with just one dose of the medicine, doctors say.

The analysis found that 39% of 2.7 million urgent care center visits and 36.4% of 58,206 visits to retail clinics were linked to antibiotic prescriptions, compared to 13.8% of 4.8 million ED visits and 7.1% of 148.5 million medical office visits. Retail clinics are embedded in grocery stores, big-box stores and pharmacy chains.

Antibiotic overuse is an enormous and growing problem around the world.

A 2041 report predicted antibiotic-resistant bacteria could kill 10 million people worldwide by 2050, which is more than the number killed by cancer and could cost the global economy $100 trillion.

In the United States, almost one-third of antibiotics - or about 47 million prescriptions dispensed every year - in doctor's offices, emergency rooms and hospital-based clinics are not needed and not effective, according to a 2016 study by the Centers for Disease Control and Prevention and the Pew Charitable Trust, the first to quantify the depth of the USA problem.

The higher chance of inappropriate antibiotic prescribing at urgent care centers and retail clinics is particularly troubling because a growing number of Americans are turning to these outpatient settings for care they can no longer afford or access in a timely fashion from a primary care provider, Redberg, a professor at the University of California San Francisco Medical Center, said by email.

CDC and Pew researchers tried to provide that information with the current study. The database only included patients with employer-sponsored insurance.

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The data show that urgent care and retail clinics are "an underrecognized source of inappropriate antibiotic prescribing", according to an accompanying commentary titled "Overprescribing in Urgent Care Clinics - The Fast and the Spurious". None were involved in the study. For example, the use of antibiotics does not alter the course of the illness for some of these conditions, and others can be caused by viruses, which should not be treated with antibiotics. Urgent care centers prescribed antibiotics in almost 46 percent of visits for these conditions. Among 9.2 million visits for colds, flu and other respiratory illnesses that don't need antibiotics, these were prescribed 17 percent of the time.

Antibiotic-resistant bacteria have evolved the ability to withstand drugs that ought to stop them.

Antibiotic use contributes to antibiotic resistance, and antibiotic overuse is common, especially for viral respiratory infections.

Fleming-Dutra said that doctors often write unnecessary prescriptions because they are concerned about missing something, and also to meet patient demands.

The finding that inappropriate antibiotic prescribing for these conditions was two to three times higher in urgent care clinics than in other outpatient settings should send a message to all providers working in urgent care, said J.D. Zipkin, MD, associate medical director of Northwell Health-GoHealth Urgent Care, a network of urgent care centers in NY. Whether it's greater in urgent care centers is unclear.

Deputy Director of the CDC Antibiotic Stewardship Office and study participant Katherine Fleming-Dutra said doctors who communicate clearly why antibiotics are not needed and what patients should do to get better are more likely to have satisfied patients, the Post reported.

Antibiotics can can also wipe out "good" bacteria in the gut that keep the body healthy in a variety of ways. These efforts will help policymakers, health care professionals, researchers, and other stakeholders ensure that antibiotics are used appropriately, and only when necessary. The groups hosted a two-day summit that ended Monday in Atlanta.

But these settings only account for about 60% of outpatient antibiotic prescriptions dispensed in the United States.

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