Nearly half of outpatient antibiotics prescribed without infection diagnosis, study finds

One in five antibiotic prescriptions are provided without an in-person visit, and about half of outpatient antibiotics are prescribed without an infection-related diagnosis, according to a study presented at IDWeek 2018, an annual meeting for infectious diseases professionals.

"We found that nearly half the time, clinicians have either a bad reason for prescribing antibiotics, or don't provide a reason at all," said lead study author Jeffrey Linder, MD. "When you consider about 80 percent of antibiotics are prescribed on an outpatient basis, that's a concern."

The researchers examined about 500,000 antibiotic prescriptions provided to more than 200,000 patients from November 2015 to October 2017. Prescribers included physicians, attending physicians, nurse practitioners and physician assistants.

Three study insights:

1. Forty-six percent of antibiotic prescriptions lacked an infection-related diagnosis, 29 percent noted something other than an infection diagnosis (such as high blood pressure or annual visit), and 17 percent were written with no diagnosis, the study found.

2. The findings stem in part from unclear diagnosis coding, but much of it reflects antibiotic prescribing for unnecessary reasons, such as prescriptions for infections caused by viruses, Dr. Linder said.

3. Of the 20 percent of antibiotics prescribed outside of an in-person visit, most were by phone (10 percent). Other prescriptions were through EHR systems.

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