Black and older patients are more likely to receive unnecessary antibiotics


April 20, 2022 — Black and older patients are more likely to be prescribed too many antibiotics, new study of 7 billion visits to health care centers finds — findings that doctors say warrant scrutiny more in-depth analysis of unequal prescribing practices.

Researchers at the University of Texas Health Sciences Center found that 64% of antibiotic prescriptions for black patients and 74% of antibiotic prescriptions for patients 65 and older were deemed inappropriate. White patients, meanwhile, received prescriptions deemed inappropriate 56% of the time.

Most of these prescriptions were written for conditions such as non-bacterial skin problems, viral respiratory tract infections and bronchitis, none of which can be treated with antibiotics.

The study – which used data from visits to US medical practices, hospitals and emergency departments – will be presented at this year’s European Congress of Clinical Microbiology and Infectious Diseases in Lisbon, Portugal, this weekend. .

The researchers also found that 58% of antibiotic prescriptions for Hispanic or Latino patients were also inappropriate.

“Our results suggest that Black and [Hispanic/Latino] patients may not be treated properly and be prescribed antibiotics even when not indicated,” said researcher Eric Young, PharmD, in a press release.

Doctors typically prescribe an antibiotic if they’re concerned a patient’s symptoms could lead to an infection, Young said. This is especially true if the doctor thinks a patient is unlikely to return for follow-up, which he says “happens more frequently in minority populations.”

the CDC estimates that at least 30% of outpatient antibiotic prescriptions are unnecessary and that up to 50% of antibiotics prescribed are either unnecessary or of the wrong type and/or dosage.

Overprescription of antibiotics has long plagued the medical field. In 2015, then-President Barack Obama’s administration released a National Action Plan to Combat Antibiotic Resistant Bacteria, with the goal of halving the unnecessary use of antibiotics in outpatient settings. 2020.

When antibiotics are overused, the bacteria that infect us evolve to become stronger and defeat the drugs that are supposed to save us.

While the findings still require further study, they offer a disturbing but unsurprising first look at health inequalities, says Rachel Villanueva, MD, president of the National Medical Association, the leading organization representing physicians and patients of African descent.

“We know that these kinds of inequalities have existed in our society for a long time,” says Villanueva, assistant clinical professor at New York University’s Grossman School of Medicine. “They are not new and have been well documented for many, many years. But it deserves further research and further evaluation.

“This is just the first step – we need to do a deeper assessment of how different communities are treated in the health care system. Why does this happen? »

For patients 65 and older, it may be less about bias and more about having trouble diagnosing certain conditions in this population, says Preeti Malani, MD, professor of infectious diseases at the University College of Medicine. University of Michigan and director of the national survey. on healthy aging.

For example, she says, some older patients may have more difficulty describing their symptoms. In some cases, doctors may give these patients a prescription to fill in case the problem does not go away, as it may be more difficult for them to return to the office.

“Sometimes it’s hard to know exactly what’s going on,” Malani says. “Something I’ve done in my own practice in the past is say, ‘I’m giving you a prescription, but I don’t want you to fill it right away.'”

Malani says the inappropriate prescription of antibiotics can be especially dangerous for people 65 and older due to drug interactions and complications like ruptured Achilles tendon and a bacterial infection called Clostridioides difficile – also known as C.diff. – which can occur after the use of antibiotics.

“We need more information about what drives this in older people,” she says.


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