Black, Senior Patients More Likely to Get Unneeded Antibiotics

Black and senior patients are more likely to be overprescribed antibiotics, according to a new study of 7 billion trips to healthcare centers — findings that doctors say warrant a further look into unequal prescription practices.

Researchers at the University of Texas Health Science Center found that 64% of antibiotic prescriptions to Black patients and 74% to patients 65 and older were deemed inappropriate. White patients, meanwhile, received prescriptions that were deemed inappropriate 56% of the time.

Most of those prescriptions were written for conditions like nonbacterial skin problems, viral respiratory tract infections, and bronchitis — none of which can be treated with antibiotics.

The study — which used data from visits to US doctors’ offices, hospitals, and emergency departments — will be presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases in Lisbon, Portugal, this weekend.

Researchers also found that 58% of antibiotic prescriptions to patients with a Hispanic or Latin American background were also not appropriate for use.

“Our results suggest that Black and [Hispanic/Latino] patients may not be properly treated and are receiving antibiotic prescriptions even when not indicated,” researcher Eric Young, PharmD, said in a news release. 

Doctors typically will prescribe an antibiotic if they fear a patient’s symptoms may lead to an infection, Young said. This is particularly true if the doctor believes a patient is unlikely to return for a follow-up, which, he says, “more frequently happens in minority populations.”

The CDC estimates that at least 30% of outpatient antibiotic prescriptions are not needed and that up to 50% of antibiotics prescribed are either unnecessary or the wrong type and/or dosage.

Overprescribing of antibiotics has long plagued the medical field. In 2015, the administration of then-President Barack Obama released a National Action Plan for Combating Antibiotic-Resistant Bacteria, with a goal to cut unneeded outpatient antibiotic use by at least half by 2020.

When antibiotics are overused, bacteria that infect us evolve to become stronger and defeat the drugs meant to save us.

Though the findings still need more study, at first glance they provide a concerning but unsurprising look at health inequities, says Rachel Villanueva, MD, president of the National Medical Association, the leading organization representing doctors and patients of African descent.

“We do know that these kinds of inequities have existed for a long time in our society,” says Villanueva, a clinical assistant professor at the New York University Grossman School of Medicine. “They’re not new and have been well-documented for many, many years. But this deserves further research and further evaluation.”

“This is just the first step — we need to do some more evaluation on how different communities are treated in the health care system. Why is this occurring?” 

For patients 65 and older, it may be less about bias and more about having a hard time diagnosing certain conditions within that population, says Preeti Malani, MD, a professor of infectious diseases at the University of Michigan Medical School and director of the National Poll on Healthy Aging.

For example, she says, some older patients may have a harder time describing their symptoms. In some cases, doctors may give these patients a prescription to fill in case the issue does not clear up, because it could be harder for them to get back into the office.

“Sometimes it’s hard to know exactly what’s going on,” Malani says. “Something I’ve done in my own practice in the past is say, ‘I’m giving you a prescription, but I don’t want you to fill it yet.’ “

Malani says inappropriately prescribing antibiotics can be especially dangerous for people 65 and older because of drug interactions and complications like Achilles tendon rupture and a bacterial infection called Clostridioides difficile – also known as C. diff. — which can arise after antibiotic use.

“We need more information on what drives this in older adults,” she says.

Sources

European Congress of Clinical Microbiology & Infectious Diseases.

CDC: “Measuring Outpatient Antibiotic Prescribing,” “CDC: 1 in 3 antibiotic prescriptions unnecessary.”

Rachel Villanueva, MD, president, National Medical Association; clinical assistant professor of obstetrics/gynecology, New York University Grossman School of Medicine.

Preeti Malani, MD, professor of infectious diseases, University of Michigan Medical School; director, National Poll on Healthy Aging.

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