August 25, 2017
Bugging clinicians about the danger of superbugs appears to be working.
The rate of outpatient antibiotic prescriptions that were filled at pharmacies for commercially insured patients declined 9% from 2010 through 2016, according to a study released yesterday by the Blue Cross Blue Shield Association (BCBSA). Significantly, the drop-off was even greater — 13% — for broad-spectrum antibiotics, the kind most likely to provoke antibiotic resistance.
The study looked at claims for filled antibiotic prescriptions for more than 31 million Americans aged less than 65 years who were insured by Blue Cross Blue Shield companies in the BCBSA.
Painting a picture of superbug catastrophes on a global scale, researchers, public health agencies, and medical societies have preached to clinicians for years on the need to prescribe antibiotics more judiciously. The BCBSA study is just one sign that the message is getting across. The Centers for Disease Control and Prevention reports that antibiotic prescribing in outpatient settings decreased by 5% from 2011 to 2014.
According to the BCBSA study, retail clinics lead the way in one important aspect. Forty-nine percent of their antibiotic scripts fall into the problematic broad-spectrum category compared with 60% for physician offices and 59% for hospital emergency departments.
Progress Is Uneven
The decline in antibiotic prescribing indicated by the change in fill rate is no cause for clinicians to rest on their laurels. In 2016, 21% of outpatient prescriptions for antibiotics were not indicated for the patient's condition, according to the BCBSA study. Most of these errant prescriptions involved broad-spectrum antibiotics.
And progress in curbing promiscuous prescribing is uneven. While antibiotic prescriptions fell off 20% or more in Hawaii, Montana, North Carolina, North Dakota, Oregon, South Dakota, and Washington, they rose 3% in both Delaware and Illinois.
Likewise, antibiotic prescribing varies greatly by state. The rate of filled antibiotic prescriptions in Mississippi last year was 123 per 100 beneficiaries, almost three times the rate of 45 per 100 in Montana. The spread was even greater among metropolitan areas — 38 per 100 beneficiaries in Missoula, Montana, versus 169 per 100 in Monroe, Louisiana.
The BCBSA study is available on the association's website.