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Such recipes can cause complications, including diarrhea, rash – ScienceDaily


According to a new study from Washington University School of Medicine in St. Louis and The Pew Charitable Trusts, improper prescribing of antibiotics to children who are not in the hospital has led to excessive health care spending in the U.S. in 2017 of at least $ 74 million.

Children who were prescribed unnecessary or unsuitable antibiotics on an outpatient basis, such as doctors and emergency departments, were also up to eight times more likely to develop complications such as diarrhea and skin rash than children treated according to standard medical guidelines.

Conclusions published on May 26 JAMA open networkemphasize the need to better manage the use of antibiotics outside hospitals.

“The misdiagnosis of antibiotics is, unfortunately, very common and leads to unavoidable side effects and health care costs,” said lead author Anne Mable Butler, Ph.D., an associate professor of infectious diseases at the University of Washington. “Sometimes parents think the worst thing that can happen is that an antibiotic just won’t help their child. But antibiotics are not harmless – they can cause side effects. Clinicians need to make sure that antibiotics are used only in this way likely to benefit the patient. ”

Antibiotics kill bacteria, not viruses, but doctors still often prescribe antibiotics for viral infections. In bacterial infections, antibiotics can be helpful, but it is important to choose the right antibiotic, and doctors do not always follow the recommendations. A previous study found that about 29% of antibiotic prescriptions for children who are not in the hospital are unsuitable.

At the population level, the use of antibiotics stimulates the development of antibiotic-resistant bacteria. Such bacteria cause difficult-to-treat infections that cause 35,000 deaths in the United States each year. But less is known about individual health risks and the economic costs associated with improper use of antibiotics.

The researchers analyzed data on private health insurance claims for children aged 6 months to 17 years, who were diagnosed with any of the eight common infections – three bacterial (ear infections with pus, sore throat and sinus infections) and five viral (ear infections without pus, bronchitis, bronchiolitis, influenza and colds). In total, they found 2.8 million children who from April 1, 2016 to September 30, 2018 from April 1, 2016 to September 30, 2018 were in clinics, emergency departments, emergency centers and doctors’ offices 2.8 million children .

Unnecessary and inappropriate antibiotic prescriptions increased the likelihood that children would encounter some medical complications. Children who received an unrecommended antibiotic for bacterial infections were three to eight times more likely to develop Clostridiodes difficile (C. diff) an infection potentially life-threatening intestinal infection with diarrhea and inflammation that is associated with disruption of a community of beneficial bacteria that normally live in the gut. They also had an increased risk of developing diarrhea that was not caused C. diff; nausea, vomiting and abdominal pain; and severe allergic reactions such as anaphylaxis. With some viral infections, children who unnecessarily received antibiotics had a higher risk of developing skin rashes or inaccurate allergies compared with children who did not receive antibiotics properly.

“Taking antibiotics when you don’t need them, or taking the wrong antibiotic when you need it, accelerates the threat of dangerous superbugs and has serious consequences for individual patients,” said David Hyun, MD, who manages the antibiotic The Pew Charitable Trusts. resistance project and is a co-author of the study. “We hope this study will serve as a roadmap to help health systems, insurers and other health organizations as they work to step up efforts to improve antibiotic prescribing, protect children’s health and save money.”

Inappropriate antibiotics, in addition to causing avoidable suffering, are expensive because they lead to antibiotic treatment failure and additional medical complications that require subsequent medical visits and prescriptions. In 2017, the wrong choice of antibiotics for bacterial ear infections cost families and insurance companies an average of $ 56 per case, which is $ 25.3 million for extra health care costs in the country, only for children with private insurance. The total cost for all children is probably much higher. Sore throats from improper treatment amounted to $ 21.3 million, sinus infections – $ 7.1 million, flu – $ 1.6 million, and colds – $ 19.1 million nationwide among children with private insurance. Unnecessary prescriptions of antibiotics for viral bronchitis or bronchiolitis did not lead to additional medical complications or unnecessary costs.

Notably, inappropriate prescriptions for viral ear infections actually saved $ 96 on a case-by-case basis, down $ 15.4 million by $ 15.4 million on health care for children with private health insurance. Researchers suspect that this may be at least in part due to errors in diagnostic coding in which some bacterial ear infections have been mistakenly classified as viral. In other words, the benefit seen in this study may be related to the correct prescribing of antibiotics for incorrectly labeled bacterial ear infections rather than to the incorrect treatment of viral ear infections.

Many hospitals have set up so-called antibiotic conservation programs to promote the proper use of antibiotics and thus reduce the spread of antibiotic resistance, reduce the number of infections caused by drug-resistant bacteria, and improve patient outcomes. Such programs are less common in outpatient facilities such as emergency centers and medical offices.

“This study continues to show that we need to do better work to ensure that antibiotics are used properly in all medical facilities,” said senior author Jason Newland, MD, professor of pediatrics at the University of Washington’s Department of Pediatric Infectious Diseases. . “Our inability to do so has my real harm to both children’s health and our collective wallet. We know how to prescribe antibiotics as recommended, and it’s time to start making more efforts to ensure that antibiotics are always used properly.”

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