Preposterous Inpatient Antibiotic Overuse

It is one matter entirely to give antibiotics for self-limited bacterial or viral conditions.  It is another matter to regularly, simultaneously prescribe multiple, redundant antibiotics with overlapping coverage, excepting a few particular situations.

And, we are clearly using overlapping coverage far more than just a few particular exceptions.

This review of proprietary data from inpatient antibiotic use in 505 U.S. hospitals between 2008 and 2011 looked at three types of antibiotic overlap – that for MRSA, for anaerobic bacteria, and for ß-lactam therapy.  These authors noted 32,507 cases in which patients received at least two consecutive days of redundant, simultaneous antibiotics.  The largest offender, by far:  82,018 days in which patients received both intravenous metronidazole and intravenous piperacillin-tazobactam.  The majority of the remainder were also anerobic overlap, and the authors also cited over a thousand cases each of dual-MRSA therapy or dual-ß-lactam therapy.

Now, there are certain tissues in which vancomycin has poor penetration, and vancomycin-intermediate strains are increasing – so it’s unreasonable to say all dual-MRSA therapy is inappropriate.  The same applies to the dual-ß-lactam therapy, as double-coverage for pseudomonas and other MDR pathogens frequently requires at least initial redundant therapy.  However, I think this data still reasonably reflects an abundance of opportunity to curtail inappropriate antibiotics use.

The authors, mostly employed by a health services consulting company, also try to do a cost-analysis to quantify the scope of the redundant use.  Unfortunately, in each case, they assume the more expensive antibiotic is the redundant one – which inflates and exaggerates their estimates.  Presumably, this comes out of the need to subsequently promote their company’s services, and these numbers are best ignored.

But, we can, at least, do much better than our present state of affairs.

“Economic Impact of Redundant Antimicrobial Therapy in US Hospitals”
http://www.ncbi.nlm.nih.gov/pubmed/25203175