UAB study describes continued inappropriate antibiotic use in ERs

UAB researchers say that antibiotics continue to be inappropriately used in emergency rooms despite worries over antibiotic resistance.

baddleyInvestigators at the University of Alabama at Birmingham say the inappropriate use of antibiotics in emergency departments is not decreasing even as concerns about antibiotic resistance continue to mount.

The research team looked at visits to emergency departments nationwide over a 10-year period and found that inappropriate antibiotic use decreased in pediatric settings, but did not decrease in adult settings. The study was published online in January in Antimicrobial Agents and Chemotherapy.

“While emergency department antibiotic use for acute respiratory tract infections decreased in the past decade among children, we saw no decrease in antibiotic use for adults with acute respiratory tract infections,” said John Baddley, M.D., associate professor in the Division of Infectious Diseases and a study co-author. “Given organized efforts to emphasize antibiotic stewardship, we expected to see a decrease in emergency department antibiotic use for such infections.”

Antibiotics are used against bacterial infections and are ineffective against infections caused by viruses. The study, which examined data from the National Hospital Ambulatory Medical Care Survey from 2001-2010, found that antibiotics were still prescribed for acute respiratory tract infections such as sinusitis and bronchitis even when those infections were caused by a virus.  Inappropriate antibiotic use is a contributing factor to antibiotic resistance, a growing concern in medicine, according to Baddley.

During the years covered in the study, acute respiratory tract infections accounted for 126 million visits to emergency departments in the United States. Such infections make up one-tenth of all ambulatory care visits nationally.

“A major reduction in use of inappropriate antibiotics in the emergency room could have a big benefit due simply to the large number of patients seen,” said John Donnelly, a pre-doctoral fellow with the UAB Center for Outcomes and Effectiveness Research and the study’s lead author. “Emergency rooms are not used just for emergencies. Many people, especially those who are uninsured, use the ER for basic primary care.”

Baddley says in recognition of the growing issue of antibiotic resistance, many hospitals have established policies for what is often called antibiotic stewardship.

“Seven years ago, UAB established an antimicrobial stewardship committee to oversee the use of antibiotics and set best practices for their administration,” said Baddley. “While that committee has seen much progress in reducing inappropriate use of antibiotics at UAB Hospital, the findings of this study indicate that nationally the emergency room is one area where we still have work to do.”

“The observed lack of change in antibiotic use for adult acute respiratory tract infection patients, especially those with infections where antibiotics are not indicated, is concerning,” said Henry Wang, M.D., vice chair for research in the UAB Department of Emergency Medicine and a study co-author. “This may indicate that efforts to curtail inappropriate antibiotic use have not been effective or have not yet been implemented in all medical settings.”

Complicating the picture, the investigators suggest that the lack of reduction in use of antibiotics in these cases may be a consequence of the difficulty of making definitive diagnoses, and the fact that patients frequently expect to receive an antibiotic and put pressure on physicians to provide them.

Baddley suggests that better education about the risk of inappropriate antibiotic use for health care providers is the key to better antibiotic stewardship.