Health experts recommend doctors examine patients, seek testing to verify antibiotics are necessary

Patients widely received antibiotics with no record of seeing a doctor, a nationwide study found, despite recommendations that doctors physically screen patients to prevent unnecessary prescriptions that could contribute to superbugs.

Researchers from Brigham and Women’s Hospital and Northwestern University looked through a decade of medical bills for 53 million people nationwide. They found nearly 83 million antibiotic prescriptions that were filled with no record of an associated doctor visit that could have verified that the antibiotics were necessary. That totaled about 28% of the 300 million antibiotics prescribed to patients, who were enrolled in Medicaid between 2004 and 2013.

Antibiotics can be highly effective in treating dangerous bacterial infections, but overuse contributes to the growth of drug-resistant superbugs. Antibiotics can wipe out some bacteria that compete with drug-resistant bugs for survival, allowing superbugs to flourish without competition.

Superbugs kill an estimated 35,000 people in the U.S. each year, the Centers for Disease Control and Prevention reported in 2019.

Public-health experts generally recommend doctors verify that antibiotics are necessary through physical examinations, laboratory or imaging tests. If ailments such as earaches, sore throats and cold-and-flu symptoms are viral rather than bacterial, antibiotics would be ineffective.

But doctors sometimes prescribe antibiotics when symptoms are initially ambiguous because patients ask for drugs, even at the risk of overusing the medication, said Sara Keller, an infectious diseases researcher and assistant professor at the Johns Hopkins University School of Medicine, who wasn’t involved in the paper.

Most antibiotics are prescribed by providers in clinics and other outpatient centers, and prior research of drugs prescribed estimates 25% to 30% are unnecessary.

Patients who take unnecessary antibiotics get no benefit from the drug but risk side effects, such as rashes or diarrhea, and complications, including life-threatening bacterial infections that blossom as antibiotics wipe out competing bacteria, said Jeffrey Linder, general internal medicine chief at Northwestern University Feinberg School of Medicine. Dr. Linder was one of the authors of the new study, which was published in the journal Health Affairs.

The study looked at medical bills for record of an office visit in the week before patients filled a prescription.

Few studies have examined antibiotics prescribed without an office visit and the new findings are an important, nationwide view into a potentially harmful practice, said researchers not involved in the work.

More from the Wall Street Journal here.