Inappropriate Antibiotic Prescribing: Wind at Our Backs or Flapping in the Breeze?

Abstract

Despite long-standing recognition by clinicians and the public, the problem of inappropriate antibiotic prescribing is, unfortunately, persistent. Inappropriate antibiotic prescribing not only harms our communities by contributing to the spread of antibiotic-resistant infections, but it also directly harms patients by leading to adverse drug events, unnecessary costs, and serious complications, such as Clostridium difficile colitis. Inappropriate antibiotic prescribing encompasses several domains (Table 1). The most important is unnecessary antibiotic prescribing (or overuse), which refers to prescribing an antibiotic when it is not indicated (eg, for a viral infection). At least 30% of all antibiotics prescribed in outpatient settings in the United States are considered unnecessary; this estimate rises to 50% for respiratory tract infections, which collectively are responsible for the largest number of antibiotic prescriptions overall.1 But there are several other important types of inappropriate antibiotic prescribing, including prescribing for an unnecessarily prolonged duration, selecting an unnecessarily broad-spectrum antibiotic, … Address correspondence to Adam L. Hersh, MD, PhD, Division of Infectious Diseases, Department of Pediatrics, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108. E-mail: adam.hersh{at}hsc.utah.edu