The Full Extent of Antibiotic Use in the United States? No One Knows.

March 31, 2017

What we know-and what we don't-about antibiotics in America.

The threat of a post-antibiotic world, where the drugs to treat infectious diseases lose their effectiveness, draws ever closer, bringing an increased awareness in the health-care world about prescribing rates. But the available information about current usage rates and patterns isn’t nearly good enough.

This lack of information is according to a new report from the Pew Charitable Trusts, which hopes to set a baseline for the information currently available. Pew is also calling for further study.

What we know now

The United States has a very high prescribing rate for antibiotics. The report cites evidence that, U.S. health-care providers wrote 835 antibiotic prescriptions for every 1,000 people. This figure is 2.5 times that of Sweden, with 328 prescriptions per 1,000 people.

Related article: 5 most over-prescribed antibiotics

Evidence also suggests much of the antibiotic prescribing in the United States is unnecessary, citing an article that shows that 30% of antibiotic prescriptions in U.S. outpatient settings were not needed, according to the Pew report. A study in hospitals found that 37% of antibiotics prescriptions were potentially unnecessary or were incorrect, either for an improper duration or an incorrect antibiotic.

Also of concern are the prescribing rates for broad-spectrum antibiotic prescriptions, which have increased, while rates for narrow-spectrum antibiotics have decreased.

What we need in the future

Though the current data reveals some important trends, there is still much that is unknown about current antibiotic prescribing rates and why antibiotics are prescribed. It appears that antibiotics are prescribed more frequently in the South and in the Midwest, but more research is needed to uncover the reasons (clinical, socioeconomic, or demographic) behind the higher rates of antibiotic prescription there.

Related Article: Risky antibiotic use threatens patients

The report concluded that the United States “lacks comprehensive data on the appropriateness of inpatient antibiotic use.” More data is needed on the conditions identified and the drugs prescribed to treat them. As of March 2016, only a small fraction of hospitals reported antibiotic use; the report recommends mandatory antibiotic reporting nationally. Additionally, the report also urges Congress to support U.S. Department of Agriculture and FDA programs to gather more data on the use of antibiotics in animals and people.

”[This data is needed to] establish a more accurate baseline of current use, identify where and what types of stewardship interventions would be most effective, and measure progress toward reducing inappropriate prescribing,” the report stated.