Have you ever visited an urgent care center or a retail clinic (like those found in some pharmacies)? Getting a quick doctor’s appointment during flu season can be challenging. It may take a week or longer to be seen. Going to the ER is also problematic. Most people are sick and tired of waiting five to ten hours in an emergency department at their local hospital. People who are feeling sick, especially if they have the flu, may opt for an urgent care center or a retail clinic instead. One big problem with that decision: unnecessary antibiotics.
Why Unnecessary Antibiotics Are a Problem:
Public health authorities and infectious disease experts have been working to reduce inappropriate use of antibiotics. A new study has found, however, that a lot of patients get unnecessary antibiotics in urgent care centers (JAMA Internal Medicine , July 16, 2018).
Antibiotic misuse is associated with bacterial resistance and diminishing value of the antibiotics. It may also lead to infections such as Clostridium difficile, which causes severe diarrhea. There are also side effects associated with some antibiotics, as we wrote about in this post:
What The Researchers Discovered:
The investigators reviewed insurance claims from 2014. This captured data on people under 65 with employer-sponsored insurance. What they found was rather shocking: Almost 40 percent of the 2.7 million urgent care center visits resulted in a prescription for an antibiotic. Approximately 16 percent of the visits to urgent care centers were for problems that shouldn’t be treated with antibiotics, such as colds. Retail clinics were no better.
In fact, 45 percent of the people at urgent care centers who were diagnosed with a problem that doesn’t respond to antibiotics got a prescription for one anyway. That compares to 25 percent of such visits in emergency departments and 17 percent in medical offices.
The authors conclude:
“The finding of the present study that antibiotic prescribing for antibiotic-inappropriate respiratory diagnoses was highest in urgent care centers suggests that unnecessary antibiotic prescribing nationally in all outpatient settings may be higher than the estimated 30%.”
“Antibiotic stewardship interventions could help reduce unnecessary antibiotic prescriptions in all ambulatory settings, and efforts targeting urgent care centers are urgently needed.”
A Personal Story About Unnecessary Antibiotics:
Over a decade ago I caught a nasty upper respiratory tract infection. It left me with a lingering cough that would not quit. The cough was especially bad at night.
I realized on a Friday afternoon that we had a big fund-raiser radio show coming up the next morning. I knew that talking on the radio would be a challenge. That afternoon I decided to head to an urgent care center. BIG MISTAKE!
- there was a surprisingly long wait.
- the clinician insisted that I needed a chest X-ray. The X-ray technician couldn’t seem to get the image right and took a whole bunch of unnecessary X-rays.
- the clinician determined that the X-rays did not show I had pneumonia. She prescribed an antibiotic anyway, which I was pretty sure would be useless. Unnecessary antibiotics at an urgent center, just like the new research estabished.
- the clinician administered a bronchodilator using an aerosol inhalator device. It didn’t help much, if at all.
- I got a call the following Monday that a radiologist had double-checked my chest X-rays and saw a spot on my lungs that worried him. I was told to come in for more X-rays. Needless to say, that totally freaked me out!
- I went to the radiology clinic and got more chest X-rays, scans and continuous radiation than I would ever want in a lifetime. At the end of the process the radiologist said he couldn’t tell what the spot was and I should come back in six months and repeat the entire process to see if the spot had grown.
Instead I opted for a CT scan at another radiology center. The radiologist there said it was a calcium deposit on a rib and nothing to worry about. Of course the CT scan meant a LOT more ionizing radiation.
My Perspective on Unnecessary Antibiotics:
My visit to the urgent care center resulted in a prescription for unnecessary antibiotics. The medicine wouldn’t have done anything for my cough. As a bonus, I got a lung-cancer scare and way more ionizing radiation than I needed. All this to determine that my “spot” was nothing to worry about.
I am sure that there are great urgent care centers and doctors who do not prescribe unnecessary antibiotics. But judging from the latest research, far too many are.
Share your own story about unnecessary antibiotics in the comment section below.
