For a few years, Tennessee has been ranked as one of the highest antibiotic prescribing states in the nation, and a recent study showing that fewer than 2% of clinicians were responsible for prescribing 25% of pediatric antibiotics is moving some to action.
Sophie Katz, MD, MPH, associate director of pediatric antimicrobial stewardship at Monroe Carell Jr. Children’s Hospital at Vanderbilt, and a team of researchers from the Tennessee Department of Health and the Tennessee Valley Healthcare System reviewed data from a 2016 statewide database to discover what was driving antibiotic prescribing in Tennessee and identify opportunities for improvement.
“We were looking for characteristics that could help us design stewardship interventions for those highest prescribing providers,” said Katz. “What we discovered was pretty surprising. We didn’t expect that such a small group of providers contributed to such a high volume of prescriptions.”
“Population-based Assessment of Patient and Provider Characteristics Influencing Pediatric Outpatient Antibiotic Use in a High Antibiotic Prescribing State” was published in Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America. The study found an average of 1,165 antibiotic prescriptions were written for every 1,000 children, 50% higher than the national pediatric prescribing rate that year. The prescribing rate was highest in children 2 years old and younger. It also reported that 360 of the 21,762 providers in the dataset, most of which were general pediatricians, were responsible for about one-fourth of the broad-spectrum antibiotics prescribed.
The team found the high prescribing practice more prevalent among physicians in rural areas and among those who graduated from medical school before 2000.
Katz said her team did not identify the need for the prescriptions, nor why the practice was more prominent among older physicians but suspects that antibiotic stewardship is a “relatively new concept,” so this group of physicians received less education on it during their training, or it is possible that their patient population is sicker and/or requires antibiotics to prevent infections.
Overprescribing antibiotics, especially broad-spectrum, can lead to antibiotic resistance, she said.
“There is more research showing that a lot of diseases are caused by viruses and antibiotics are not always necessary for treating illnesses. Everybody is a player in antibiotic prescribing, including the patient. We all need to change our culture when it comes to antibiotics.”
Katz plans to do additional research to look at what is driving high prescribers’ decisions to prescribe antibiotics, which could help in the state health department’s efforts to begin educational programming and peer comparison interventions to raise awareness about appropriate antibiotic use.
She said the study findings could be helpful in other high-prescribing states, including Alabama, Mississippi, Kentucky, Louisiana and Arkansas, to identify interventions to reduce unnecessary antibiotic prescribing.
