One would think educational efforts regarding the inefficacy of antibiotics for viruses would at some point take root. I’m pretty sure it’s explicitly covered in our medical school curriculum that antibiotics are indicated specifically to treat infection caused by bacteria. Despite this, however, the overwhelming evidence is that clinicians have somehow forgotten these basic fundamentals of medicine.
This is a research letter reviewing the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (NAMCS,NHAMCS) databases for visits to primary care or Emergency Departments for code 1455: “sore throat”. Considering the prevalence of group A strep infection is about 10%, and a small number of additional cases are pathogenic bacterial infections requiring acute treatment, I suppose you would expect the rate of antibiotic prescribing to be quite low?
Is 60% the number you had in mind?
U.S. physicians have been prescribing antibiotics at a mostly steady rate of 60% of visits for sore throat for over a decade. Not only are they prescribing antibiotics, almost half of prescriptions are for non-ß-lactam antibiotics – including a huge proportion of azithromycin, as if there weren’t enough macrolide-resistant streptococci out there. Beyond that, a full 15% were not even close to options on the recommended list for acute sore throat, such as fluoroquinolones.
When smart folks like David Newman are calling for the end of routine treatment of strep throat, certainly we are way off base with a 60% rate of treatment. Forget about OP-15 – we should have a quality measure based on rates of antibiotic prescription for sore throat and ear pain.
“Antibiotic Prescribing to Adults With Sore Throat in the United States, 1997-2010”
http://archinte.jamanetwork.com/article.aspx?articleid=1745694 (free online access)