According to a new study from the Washington University School of Medicine in St. Louis and The Pew Charitable Trusts, antibiotics inappropriately prescribed to out-of-hospitalized children resulted in at least $74 million in additional health care costs in the US in 2017.
Children prescribed unnecessary or inappropriate antibiotics in outpatient clinics, such as doctor’s offices and emergency care centers, were also up to eight times more likely to have complications such as diarrhea and rashes than children treated according to standard medical guidelines.
The findings, published May 26 in JAMA network openedemphasize the need to better manage the use of antibiotics outside the hospital setting.
Unfortunately, inappropriate antibiotic prescribing is common, leading to drug side effects and millions of dollars in avoidable health care costs. sometimes parents think the worst that can happen is that the antibiotic just won’t help their child. But antibiotics are not harmless – they can cause side effects. Clinicians need to ensure that antibiotics are only used in the way that is likely to benefit the patient.”
Anne Mobley Butler, PhD, lead author, assistant professor of medicine in the Division of Infectious Diseases at Washington University
Antibiotics kill bacteria, not viruses, but doctors still often prescribe antibiotics for viral infections. For bacterial infections, antibiotics can be helpful, but it’s important to choose an appropriate antibiotic, and doctors don’t always follow guidelines. A previous study suggests that about 29% of antibiotic prescriptions for out-of-hospitalized children across the country are inappropriate.
At the population level, antibiotic use stimulates the development of antibiotic-resistant bacteria. Such bacteria cause difficult-to-treat infections that lead to 35,000 deaths in the US each year. But less is known about the individual health risks and economic costs associated with inappropriate antibiotic use.
The researchers analyzed private health insurance data for children ages 6 months to 17 who were diagnosed with one of eight common infections; three bacterial (ear infections with pus, sore throat and sinusitis) and five viral (ear infections without pus, bronchitis, bronchiolitis, flu and cold). In all, between April 1, 2016 and September 30, 2018, they identified a total of 2.8 million children seen for such infections in clinics, emergency rooms, urgent care centers and doctor’s offices.
Unnecessary and inappropriate antibiotic prescriptions increased the likelihood that children would develop certain medical complications. Children given a non-recommended antibiotic for bacterial infections had a three to eight times higher risk of developing Clostridiodes difficile (C. diff) infection, a potentially life-threatening intestinal infection with diarrhea and inflammation associated with disturbances in the community of beneficial bacteria that normally live in the gut. They also had an increased risk of developing diarrhea not caused by: C. difference† nausea, vomiting and stomach ache† and severe allergic reactions such as anaphylaxis. For some viral infections, children who were given antibiotics unnecessarily had a higher risk of developing rashes or unspecified allergies compared to children who were not given an antibiotic appropriately.
“Taking antibiotics when they are not needed, or taking the wrong antibiotic when needed, accelerates the threat of dangerous superbugs and seriously affects individual patients,” says David Hyun, MD, who leads the antibiotic at The Pew Charitable Trusts. resistance project and is a co-author of the study. “We hope this research will serve as a roadmap to help health systems, insurers and other healthcare organizations strengthen their efforts to improve antibiotic prescribing, protect children’s health and save money.”
Aside from causing avoidable misery, inappropriate antibiotics are expensive as they lead to antibiotic treatment failure and additional medical complications requiring follow-up health care visits and prescriptions. In 2017, inappropriate antibiotic selection for bacterial ear infections cost families and insurance companies an average of $56 per case, representing $25.3 million in additional health care costs nationally just for children with private insurance. The total cost for all children is likely to be much greater. Inappropriately treated sore throats were $21.3 million, sinus infections $7.1 million, the flu $1.6 million and the common cold $19.1 million nationally in children with private insurance. Unnecessary antibiotic prescriptions for viral bronchitis or bronchiolitis did not lead to additional medical complications or high costs.
Remarkably, inappropriate prescriptions for viral ear infections actually saved $96 per case, for a $15.4 million national cut in health care costs for children with private health insurance. The researchers suspect that this is at least partly due to errors in diagnostic coding, with some bacterial ear infections being mistakenly classified as viral ear infections. In other words, the benefit seen in this study may be due to correctly prescribing antibiotics for mislabeled bacterial ear infections as opposed to incorrectly treating viral ear infections.
Many hospitals have established so-called antibiotic management programs to promote the correct use of antibiotics and thereby reduce the spread of antibiotic resistance, reduce the number of infections caused by multidrug-resistant bacteria and improve patient outcomes. Such programs are less common in outpatient settings such as urgent care centers and physician offices.
“This study continues to show that we need to do better to ensure that antibiotics are used appropriately in all healthcare settings,” said senior author Jason Newland, MD, a professor of pediatrics at Washington University in the Division of Pediatric Infectious Diseases. . † “If we don’t, there will be real costs, both to children’s health and to our collective wallet. We know how to prescribe antibiotics according to guidelines, and it’s time we put more effort into ensuring that antibiotics always be used correctly.”
Butler, A.M., et al. (2022) Association of Inappropriate Outpatient Pediatric Antibiotic Prescriptions with Drug Side Effects and Health Care Expenses. JAMA network opened† doi.org/10.1001/jamanetworkopen.2022.14153†
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