text: Importance The National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal of reducing inappropriate outpatient antibiotic use by 50% by 2020, but the extent of inappropriate outpatient antibiotic use is unknown. 
   
   Objective To estimate the rates of outpatient oral antibiotic prescribing by age and diagnosis, and the estimated portions of antibiotic use that may be inappropriate in adults and children in the United States. 
   
   Design, Setting, and Participants Using the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, annual numbers and population-adjusted rates with 95% confidence intervals of ambulatory visits with oral antibiotic prescriptions by age, region, and diagnosis in the United States were estimated. 
   
   Exposures Ambulatory care visits. 
   
   Main Outcomes and Measures Based on national guidelines and regional variation in prescribing, diagnosis-specific prevalence and rates of total and appropriate antibiotic prescriptions were determined. These rates were combined to calculate an estimate of the appropriate annual rate of antibiotic prescriptions per 1000 population. 
   
   Results Of the 184 032 sampled visits, 12.6% of visits (95% CI, 12.0%-13.3%) resulted in antibiotic prescriptions. Sinusitis was the single diagnosis associated with the most antibiotic prescriptions per 1000 population (56 antibiotic prescriptions [95% CI, 48-64]), followed by suppurative otitis media (47 antibiotic prescriptions [95% CI, 41-54]), and pharyngitis (43 antibiotic prescriptions [95% CI, 38-49]). Collectively, acute respiratory conditions per 1000 population led to 221 antibiotic prescriptions (95% CI, 198-245) annually, but only 111 antibiotic prescriptions were estimated to be appropriate for these conditions. Per 1000 population, among all conditions and ages combined in 2010-2011, an estimated 506 antibiotic prescriptions (95% CI, 458-554) were written annually, and, of these, 353 antibiotic prescriptions were estimated to be appropriate antibiotic prescriptions. 
   
   Conclusions and Relevance In the United States in 2010-2011, there was an estimated annual antibiotic prescription rate per 1000 population of 506, but only an estimated 353 antibiotic prescriptions were likely appropriate, supporting the need for establishing a goal for outpatient antibiotic stewardship. ||||| MAY 02, 2016 
   
   Allison Gilchrist, Associate Editor 
   
   About 30% of all outpatient oral antibiotic prescriptions written in the United States are inappropriate, a new CDC study suggests.CDC researchers used data from the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to determine the rates of outpatient oral antibiotic prescribing by patient age and diagnosis, as well as the estimated amount of antibiotic use that could be considered inappropriate.Of the 184,032 outpatient visits included in the data, 12.6% resulted in an antibiotic prescription. The researchers estimated that 353 of the 506 antibiotic prescriptions written annually per 1000 population were appropriate.Broken down further, the data revealed that sinusitis diagnoses resulted in the most antibiotic prescriptions per 1000 population (56), followed by ear infections (47), and pharyngitis (43).“Half of antibiotic prescriptions for acute respiratory conditions may have been unnecessary, representing 34 million antibiotic prescriptions annually,” the researchers wrote. “Collectively across all conditions, an estimated 30% of outpatient oral antibiotic prescriptions may have been inappropriate.”Last fall, the President signed an Executive Order on “detecting, preventing, and controlling antibiotic-resistant microbes” as part of the White House’s 5-year National Action Plan for Combating Antibiotic-Resistant Bacteria, which aims to reduce inappropriate antibiotic use in outpatient settings by 50% by 2020. Based on the current study results, a 15% reduction in overall antibiotic use would be necessary in order to meet that goal, the researchers noted.Because antibiotic overprescribing contributes to drug resistance, curbing the practice is a major public health care priority. Failure to do so could have grim consequences, as the CDC already estimates that 2 million individuals are infected with antibiotic-resistant bacteria each year in the United States, and 23,000 of them die from these infections annually.In one of the more notorious examples , UCLA Health indicated that 179 patients might have been infected with “ superbug ” carbapenem-resistant Enterobacteriaceae at the Ronald Reagan UCLA Medical Center during “complex endoscopic procedures that took place between October 2014 and January 2015.”“Health professionals generally know when antibiotics are and are not needed,” lead study author Katherine Fleming-Dutra, MD, a medical epidemiologist with the CDC’s Office of Antibiotic Stewardship, explained to Pharmacy Times. “Often, clinicians are worried about patient satisfaction. They think that a patient wants antibiotics…sometimes leading them to prescribe when they shouldn’t.”Pharmacists can help prevent this by providing patients with information about the potential consequences of unnecessary antibiotic use.“Pharmacists are the last health professional to see a patient when an antibiotic is prescribed,” Dr. Fleming-Dutra said. “When dispensing antibiotics, pharmacists can educate patients about properly taking antibiotics and about potential harms from antibiotics such as allergies, adverse events, and antibiotic resistance.”Beyond treating infections, other studies have found that as many as 1 in 10 health care providers prescribe antibiotics for almost every patient they see with a cold or bronchitis, despite the fact that antibiotics aren’t effective against viral infections.“It is important for all health professionals in all regions seeing patients of all ages to only prescribe antibiotics when they are needed, and if needed, select the right antibiotic at the right dose for the right duration,” Dr. Fleming-Dutra advised.The current study results appeared in the May 3, 2016, edition of JAMA. ||||| WASHINGTON—The Pew Charitable Trusts and the Centers for Disease Control and Prevention (CDC) released today a first-of-its kind analysis of antibiotic use in doctors’ offices, emergency rooms, and hospital-based clinics in the United States. The analysis, conducted in partnership with a panel of leading antibiotic use experts, identifies acute respiratory conditions as key drivers of antibiotic overuse in human health care and establishes data-driven targets for eliminating the approximately 47 million unnecessary antibiotic prescriptions issued in outpatient facilities across the country every year. 
   
   The findings are outlined in two documents released today: Pew’s report “Antibiotic Use in Outpatient Settings” and “Prevalence of Inappropriate Antibiotic Prescriptions Among U.S. Ambulatory Care Visits, 2010-2011,” an article authored by experts from Pew, CDC, and members of the panel, appearing in the current issue of the Journal of the American Medical Association. They outline the baseline analysis and condition-specific targets, as well as practical strategies to improve prescribing. 
   
   “This report provides the most in-depth picture to date of outpatient antibiotic prescriptions in the U.S. and will serve as a benchmark in measuring progress moving forward,” said David Hyun, M.D., a senior officer with Pew’s antibiotic resistance project, who focuses on research and policy development pertaining to the stewardship of antibiotics in health care settings. “While our estimates of unnecessary antibiotic use are conservative, it is clear that a small number of health conditions constitute the lion’s share of unwarranted antibiotic prescriptions in this country. These detailed data will help health care providers target stewardship efforts where they can do the most good.” 
   
   At least 30 percent of antibiotics prescribed in outpatient settings in the United States are unnecessary, according to the report. The majority are prescribed for acute respiratory conditions such as colds, sore throats, bronchitis, flu, and other viral illnesses that do not respond to antibiotics. 
   
   “The more antibiotics are used, the less effective they become. Reducing the needless use of antibiotics will slow the emergence of antibiotic-resistant microbes, so-called superbugs, which are among the most urgent public health threats of our time,” said Kathy Talkington, director of Pew’s antibiotic resistance project. “Patients and health care providers must work together to understand when antibiotics will help and when they won’t, and help preserve these lifesaving drugs for patients who really need them.” 
   
   Antibiotic use in outpatient settings represents the majority of dollars spent on antibiotics for human health care in the United States, and outpatient providers are often the first place patients go for health care when suffering from a cold, flu, sore throat, or other common condition for which antibiotics are often unnecessarily prescribed. 
   
   The analysis concludes that: 
   
   Approximately 13 percent of all outpatient office visits in the United States, or about 154 million visits annually, result in an antibiotic prescription; about 30 percent of these prescriptions are unnecessary. 
   
   Forty-four percent of outpatient antibiotic prescriptions are written to treat patients with acute respiratory conditions, such as sinus infections, middle ear infections, pharyngitis, viral upper respiratory infections (i.e., the common cold), bronchitis, bronchiolitis, asthma, allergies, influenza, and pneumonia. Half of these prescriptions are unnecessary. 
   
   In 2015, the White House released a national action plan for combating antibiotic resistance, which included the goal of reducing inappropriate outpatient antibiotic use by 50 percent by 2020. Based on the panel’s estimate of unnecessary prescribing, this goal would be reached by reducing outpatient antibiotic use by 15 percent overall, which would result in approximately 23 million fewer antibiotics prescribed annually by 2020. 
   
   The panel outlined actions that health care providers, patients, and the health care industry as a whole can take to reach the targets, including: 
   
   Individual outpatient health care providers can evaluate their own prescribing habits as well as implement stewardship activities in their practices. 
   
   Health systems can provide expertise and resources to offices within their network to aid in stewardship implementation. 
   
   Health plans can assist in data collection and analysis—evaluating the antibiotic prescribing habits of their providers and providing feedback that highlights potential areas for improvement. 
   
   State and local health agencies can help provide outpatient facilities with information on best practices for implementing antibiotic stewardship programs, and help develop regional partnerships between various health care stakeholders, such as providers, health plans, and health systems, in order to better coordinate stewardship activities. 
   
   Federal agencies can track antibiotic prescribing at the national level, identifying areas for further improvement and providing technical assistance to stakeholders interested in implementing stewardship efforts of their own. 
   
   Organizations such as the National Committee for Quality Assurance that develop standards to assess the quality of health care services can establish metrics to assess the antibiotic prescribing habits of health care providers. 
   
   Health care professional societies can provide expert guidance to their members on appropriate antibiotic prescribing and incorporating diagnostics to aid in prescribing decision-making. 
   
   “Prescribing unnecessary antibiotics is just one element of inappropriate use of antibiotics,” said Lauri Hicks, D.O., director of the CDC’s Office of Antibiotic Stewardship in the Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases. “Health care providers can also prescribe antibiotics at the wrong dose or for the wrong duration, amplifying the extent of inappropriate use. Setting a national target to reduce unnecessary antibiotic use is the first step, and we must work together across the health care continuum to reach this goal.” 
   
   Pew, CDC, and the expert panel are preparing a similar report on inpatient antibiotic prescribing. It will set national targets for reducing unnecessary use in hospitals and will be released in 2017. 
   
   The Pew Charitable Trusts is driven by the power of knowledge to solve today’s most challenging problems. Learn more at www.pewtrusts.org. ||||| Antibiotic resistance is one of the biggest public health challenges of our time. In 2013, CDC published a comprehensive analysis outlining the top 18 antibiotic-resistant threats in the U.S., titled Antibiotic Resistance Threats in the United States, 2013 (AR Threats Report). The report sounded the alarm to the danger of antibiotic resistance, stating that each year in the U.S., at least 2 million people get an antibiotic-resistant infection, and at least 23,000 people die. 
   
   The report ranked the 18 threats (bacteria and fungi) into three categories based on level of concern to human health—urgent, serious, and concerning—and identified: 
   
   Minimum estimates of morbidity and mortality from antibiotic-resistant infections 
   
   People at especially high risk 
   
   Gaps in knowledge about antibiotic resistance 
   
   Core actions to prevent infections caused by antibiotic-resistant bacteria, and slow spread of resistance 
   
   What CDC was doing at that time to combat the threat of antibiotic resistance 
   
   The data below is pulled from the 2013 Threats Report. CDC is working towards releasing an updated AR Threats Report in fall 2019. ||||| 
   
   iStock 
   
   This post has been updated. 
   
   Nearly a third of antibiotics prescribed in doctors' offices, emergency rooms and hospital-based clinics in the United States are not needed, according to the most in-depth study yet to examine the use and misuse of these life-saving drugs. 
   
   The finding, which has implications for antibiotics' diminished efficacy, translates to about 47 million unnecessary prescriptions given out each year across the country to children and adults. Most of these are for conditions that don't respond to antibiotics, such as colds, sore throats, bronchitis, flu and other viral illnesses. 
   
   Although health officials have been warning for decades about the overuse of antibiotics and its contribution to the development of drug-resistant bacteria, the research from the Centers for Disease Control and Prevention and the Pew Charitable Trust is the first to quantify the depth of the problem. 
   
   "We've all been hearing, 'This is a problem, this is problem,' and we all understood the general concept that there is a lot of antibiotic use," said David Hyun, a senior officer with Pew's antibiotic resistance project and one of the authors of the report published Tuesday in JAMA. Pew also published a companion report using the same data. 
   
   "Why this study is so important: It actually provides concrete numbers," Hyun said. 
   
   [CDC warns that Americans may be overmedicating young children with ADHD] 
   
   The study analyzed data for all antibiotic use in the three settings as collected from two major CDC surveys from 2010 to 2011. Antibiotic prescriptions written there represent the majority of dollars spent on antibiotics in this country. 
   
   “Antibiotics are life-saving drugs, and if we continue down the road of inappropriate use we’ll lose the most powerful tool we have to fight life-threatening infections,” said CDC Director Tom Frieden. “Losing these antibiotics would undermine our ability to treat patients with deadly infections [and] cancer, provide organ transplants and save victims of burns and trauma.” 
   
   [‘Looming catastrophe’: These 7 emergency surgeries account for 80 percent of deaths and costs] 
   
   Among the key findings: 
   
   • About 13 percent of all outpatient visits in the United States -- about 154 million visits annually -- result in an antibiotic prescription. 
   
   • More than four in 10 (44 percent) of antibiotic prescriptions are written to treat patients with acute respiratory conditions, such as sinus infections, middle ear infections, sore throats, colds, bronchitis, asthma, allergies, flu, and pneumonia. 
   
   • Half of these prescriptions are unnecessary because many are for viral illnesses. 
   
   Doctors often wind up prescribing antibiotics because of pressure from patients or parents, said Katherine Fleming-Dutra, a CDC medical epidemiologist and report's lead author. 
   
   "Clinicians are concerned about patient satisfaction and the patient demand for antibiotics," she said. But the majority of individuals do trust their doctors to make the right diagnosis, and better communication by doctors about the dangers of antibiotic overuse can lead to more appropriate prescribing, she said. 
   
   An accompanying editorial in JAMA noted that the numbers provided in the report likely are an undercount because they don't include the times antibiotics are given when patients talk to doctors' offices over the telephone, or when patients seek medical care at urgent care clinics, retail pharmacies and dentists' offices. 
   
   Also not included are prescriptions written by nurse practitioners and physician assistants. 
   
   But even relatively simple steps, such as displaying a poster in patient waiting rooms can cut down on antibiotic prescribing, the editorial said. 
   
   The overuse of antibiotics has led to the frightening rise of drug-resistant superbugs in recent years. The CDC has warned that "nightmare bacteria" are increasingly resistant to even the strongest antibiotics, posing a growing threat to hospitals and nursing homes nationwide. 
   
   Last year, the White House announced an aggressive plan to combat antibiotic-resistant bacteria, which already cause an estimated 2 million illnesses and 23,000 deaths every year just in the United States. The administration set a target of reducing inappropriate antibiotic use in outpatient settings by half by 2020. 
   
   Based on the new report, this goal would be reached by cutting outpatient antibiotic use by 15 percent overall, which would result in approximately 23 million fewer antibiotics prescribed annually by 2020. 
   
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   CDC warns that Americans may be overmedicating young children with ADHD 
   
   ‘Looming catastrophe’: These 7 emergency surgeries account for 80 percent of deaths and costs
target: – Scientists have been concerned for some time about "Phantom Menace"-type superbugs that aren't fazed by meds. The latest CDC data finds that 2 million people a year in the US are infected with bacteria resistant to antibiotics, and at least 23,000 die directly from those infections. And a new report from the CDC and the Pew Charitable Trusts—the first research to quantify this issue, per the Washington Post—isn't encouraging. A study published Tuesday in JAMA finds nearly one in three antibiotic prescriptions (around 47 million per year) are given needlessly to people with viruses such as bronchitis and the common cold, as well as for ear and sinus infections and sore throats not caused by bacterial infections—meaning the Rx not only won't vanquish their illness, but can potentially build up antibiotic resistance, the St. Louis Post-Dispatch reports. Besides the drug resistance, overuse can up the risk for drug allergies and even an unpleasant-sounding diarrhea that can be fatal. The researchers analyzed 184,032 outpatient visits to ERs and medical clinics in 2010 and 2011 and found that 12.6% walked out with an antibiotic script, per the Pharmacy Times. Out of an estimated annual antibiotic-prescription rate of 506 per every 1,000 people, only about 353 of those who received prescriptions should likely have received them. The Times notes President Obama's initiative to cut down on unnecessary outpatient antibiotic use by 50% by 2020; researchers say that, based on this study, we'll need to slash overall antibiotic use by 15% to meet that. "If we continue down the road of inappropriate use we'll lose the most powerful tool we have to fight life-threatening infections," CDC Director Tom Frieden says. "Losing these antibiotics would undermine our ability to treat patients with deadly infections [and] cancer, provide organ transplants, and save victims of burns and trauma." (Here's hoping teixobactin can help us out with superbugs.)