Antibiotic Use in Cold and Flu Season and Prescribing Quality

Abstract

Background Excessive antibiotic use in cold and flu season is costly and contributes to antibiotic resistance. The study objective was to develop an index of excessive antibiotic use in cold and flu season and determine its correlation with other indicators of prescribing quality. Methods and Findings We included Medicare beneficiaries in the 40% random sample denominator continuously enrolled in fee for service benefits for 2010 and/or 2011 (7,961,201 person-years (PY)) and extracted data on prescription fills for oral antibiotics that treat respiratory pathogens. We collapsed the data to the state-level so that it could be merged with monthly flu activity data from the Centers for Disease Control and Prevention (CDC). Linear regression, adjusted for state-specific mean antibiotic use and demographic characteristics, was used to estimate how antibiotic prescribing responded to state-specific flu activity. There was considerable geographic variation in flu-associated antibiotic use across states—lowest in Vermont and Connecticut and highest in Mississippi and Florida. There was a robust positive correlation between medications that often cause adverse events in the elderly and flu-associated prescribing (0.755; p<0.001), while there was a strong negative correlation with beta-blocker use after a myocardial infarction (MI) (−0.413; p=0.003). Conclusion Adjusted flu-associated antibiotic use was positively correlated with high-risk medications to the elderly and negatively correlated with beta-blocker use post MI. These findings suggest excessive antibiotic use reflects low quality prescribing, and imply that practice and policy solutions should go beyond narrow, antibiotic-specific, approaches to encourage evidence-based prescribing for the elderly Medicare population.

Regional variation in antibiotic prescribing among medicare part D enrollees, 2013

“…[6] Conversely, areas with higher rates of 4-year college education and per capita income had lower rates of antibiotic prescribing [6]. At least one study has suggested that excessive antibiotic use is only one component of a more broad pattern low-quality prescribing in certain locations [13]. Other research suggests that variations in antibiotic use are likely due to a wide range of factors which vary between regions, including comorbidities, patient attitudes towards healthcare, formulary restrictions, physician values, practice volume, and medical culture in general [11].…”

The Impact of Influenza Vaccination on Antibiotic Use in the United States, 2010–2017

“…We analyzed the impact of vaccination on prescribing by age group, pediatric (0–18 years), adult (19–64 years), and elderly (≥65 years), to account for differences in influenza susceptibility and attack rates by age. Because rates of influenza-like illness are strongly associated with prescribing of certain classes of antibiotics, particularly broad-spectrum penicillins, cephalosporins, macrolides, and fluoroquinolones [ 31 ], we evaluated the effect of influenza vaccination on consumption of these antibiotic classes, both overall and for each age group.…”

Einstein's Special Principle of Relativity and Biological Resistance Control

“…The foregoing analysis also implies that, contrary to currently-held beliefs and arguments, neither over-prescription of antibiotics by physicians [16] nor patient noncompliance with prescribed drugs [17] nor supposed abuse of antibiotics by populations [18], etc. is the reason for resistance emergence; that the design of antimicrobials contains a subtle flaw to be rectified; and that had the design not contained such a flaw, we wouldn't have been encountering resistance.…”