Unnecessary antibiotics are far from harmless

A fifth of hospitalized patients on antibiotics had negative side effects, a study shows. And some of the drugs weren't needed in the first place.

In a new study, a fifth of hospitalized patients on antibiotics suffered negative side effects, some of which could have been avoided since the drugs weren’t needed in the first place.

“Antibiotics have the potential to cause real harm to patients,” says lead author Pranita Tamma, assistant professor of pediatrics at Johns Hopkins University and director of the hospital’s pediatric antimicrobial stewardship program.

“…we need to pause and ask ourselves, ‘Does this patient really need an antibiotic?'”

“Each time we think to prescribe an antibiotic, we need to pause and ask ourselves, ‘Does this patient really need an antibiotic?'” she says. “If the patient develops an antibiotic-associated adverse reaction, even though that is, of course, unfortunate, we should be able to take some comfort in knowing that at least the antibiotic was truly necessary.”

For the study, published in JAMA Internal Medicine, researchers evaluated the electronic medical records of 1,488 adults admitted to Johns Hopkins for a variety of reasons, including trauma and chronic disease. All received at least 24 hours of antibiotic treatment.

Overall, 20 percent of patients experienced one or more adverse effects, such as gastrointestinal, kidney, and blood abnormalities from taking antibiotics. Each additional 10 days of antibiotics increased the risk of side effects by 3 percent.

Adverse events also included Clostridium difficile infection—a bacterial cause of diarrhea that can become severe—and development of new multidrug-resistant infections. Ninety days out, 4 percent and 6 percent of patients, respectively, developed C. difficile infection or potential multidrug-resistant organism infections.

While the study uncovered no deaths due to antibiotic side effects, a significant number of patients had prolonged hospital stays, repeat hospital admissions, additional emergency department or clinic visits, or additional diagnostic tests.

The study showed that 19 percent of antibiotics prescribed to patients in the study were clinically unnecessary. In those cases, two infectious disease experts found no indication in medical records of bacterial infections that should trigger a course of antibiotics. The rate of adverse effects suffered in this group was the same as for the overall group, 20 percent, Tamma says.

Patients should be encouraged to ask questions and understand the risks about taking antibiotics, Tamma says.

“I think it’s good for patients to ask their doctors about potential side effects and how to recognize them. That alone could reduce a large portion of unnecessary antibiotic prescribing.

“Too often, clinicians prescribe antibiotics even if they have a low suspicion for a bacterial infection, thinking that even if antibiotics may not be necessary, they are probably not harmful. But that is not always the case.”

Pfizer Independent Grants for Learning and Change and the Joint Commission funded the work.

Source: Johns Hopkins University

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