Medicaid disproportionally overuses Antibiotics creating anti biotic resistance

. Non-Infection-Related And Non-Visit-Based Antibiotic Prescribing Is Common Among Medicaid Patients

Michael A. Fischer (mfischer@partners.org) is an associate professor of medicine at Harvard Medical School and an associate physician in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, both in Boston, Massachusetts. Mufaddal Mahesri is a research specialist in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital. Joyce Lii is a programmer in the Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital. Jeffrey A. Linder is the Michael A. Gertz Professor of Medicine in the Division of General Internal Medicine and Geriatrics, Northwestern University Feinberg School of Medicine, in Chicago, Illinois. – op

Ambulatory antibiotic stewardship policies focus on prescribing decisions made when patients present to clinicians with possible infections. They do not capture antibiotics prescribed outside of clinician visits or without clear indications for use. Antibiotic prescribing for vulnerable patients in the US has not been comprehensively measured. We measured the frequency with which all filled antibiotic prescriptions were associated with infections and in-person visits for Medicaid patients in the period 2004–13. We found that among 298 million antibiotic fills (62 percent for children) for 53 million patients, 55 percent were for clinician visits with an infection-related diagnosis, 17 percent were for clinician visits without an infection-related diagnosis, and 28 percent were not associated with a visit. Non-visit-based antibiotic prescriptions were less common for children than for adults and more common in the West than in other US regions. Large fractions of antibiotic prescriptions are filled without evidence of infection-related diagnoses or accompanying clinician visits. Current ambulatory antibiotic stewardship policies miss about half of antibiotic prescribing.

The rate of antibiotics prescribed in the US is about double that in many other countries.1–3 Approximately 80 percent of US antibiotic prescribing occurs in ambulatory care, and there is marked geographic and specialty variability—with family practice, pediatrics, and internal medicine accounting for most antibiotic prescriptions.4,5 Antibiotics are one of the most commonly identified classes of medications associated with adverse drug events.6,7 Potential complications include rashes, diarrhea,8 and Clostridioides difficile infection.9 Antibiotic overuse also contributes to the development of antibiotic resistance, and already each year more than two million people in the US are sickened with and 23,000 die from infections caused by antibiotic-resistant bacteria.10 Antibiotic-resistant infection treatment costs in the US have doubled since 2002 and now exceed $2 billion annually.11