Antibiotic overuse is a major problem throughout the world. Now a new study finds four in 10 outpatients were inappropriately prescribed antibiotics at a major U.S. Veterans Affairs health system.

That rate is higher than in previous studies on outpatient antibiotic use. Improper use of the drugs is associated with increased illness, cost and the spread of antibiotic-resistant bacteria.

"Our study targeted the most commonly overused antibiotics and the associated conditions in order to enable an approach focused on these factors in the outpatient setting," said study author Alexis White.

Over-prescription of antibiotics was most common in patients with urinary tract infections, bronchitis, skin infections and sinusitis, according to the analysis of data from researchers with the Veterans Affairs Western New York Healthcare System.

Among patients diagnosed with sinusitis, 32% did not require an antibiotic because their symptoms were consistent with the common cold. And the incorrect drug was chosen in 53% of cases.

In urinary tract infection cases, the correct drug was chosen in only 55% of cases. Antibiotics were most commonly prescribed for asymptomatic urine bacteria, a condition that does not require antibiotics.

The study also found that the most commonly overused antibiotics included azithromycin, ciprofloxacin, amoxicillin/clavulanate, and cephalexin. Together, the four drugs accounted for nearly 80% of unnecessary antibiotic use.

Of the 288 prescriptions for azithromycin, 55% were unnecessary. The drug was most commonly misused for bronchitis, sinusitis, upper respiratory tract infections, chronic obstructive pulmonary disease, and community acquired pneumonia.

The researchers also found that patients seen in emergency departments were twice as likely to receive an antibiotic only when needed, compared to those seen in outpatient clinics.

This suggests that patients seen in an emergency department are more likely to actually require antibiotics.

Outpatient antibiotic prescriptions comprise 60% of overall antibiotic use, making them a critical target for reducing unnecessary antibiotic use, the researchers said.

The study was published recently in the American Journal of Infection Control.

"We found that real-time alerts when an antibiotic is prescribed, allowing for immediate intervention, may be an effective way to begin a stewardship program, supplemented by patient education on when an antibiotic is not needed and the harmful effects of misuse," White said in a journal news release.

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