A study was recently published in the Journal of the American Medical Association (JAMA) looking at unnecessary antibiotic prescription practices in different medical settings: doctors’ offices, emergency rooms, urgent care centers, and retail based clinics (clinics inside of stores like Walmart or CVS). Antibiotics are used to treat bacterial infections. The study found that nearly half (46%) of people seeking treatment in urgent care centers for viral illnesses like colds, flu, bronchitis/bronhiolitis, ear infections without pus behind the ear drum, and viral pneumonia and for things like asthma and allergies were prescribed antibiotics. That is nearly 3 times the rate of inappropriate prescription in medical offices (17%) and twice as high as emergency departments. Retail clinics actually had the lowest rate of inappropriate antibiotic prescriptions at 14%.
Why does this matter? Antibiotic overuse contributes to antibiotic resistance and the rise of "superbugs" like MRSA. Your body contains as many as 100 trillion organisms that are part of your microbiome. There are more cells of "not you" than cells of "you." The more antibiotics you take, the more antibiotics your microbiome population is exposed to, and the more resistance they can develop. Currently, it is estimated that 700,000 people die every year around the world from antibiotic resistant organisms, but a report out of the UK estimates this number to increase to 10 million around the world by 2050. Any antibiotic exposure also increases the risk of having an adverse reaction, such as vomiting or rash, developing an allergy to the antibiotic, or developing another infection as a side effect of the antibiotic, such as c. diff diarrhea.
The article discusses the convenience of urgent care clinics' evening and weekend hours and lower cost, which may be prompting “frequent visits for mild self-resolving illnesses that would be better treated with rest and symptom management at home.” Clinicians at urgent care clinics may be more likely to prescribe antibiotics, because they are less able to convince patients that don't know and trust them that an antibiotic is not necessary. Some patients go to urgent care for an antibiotic and expect a prescription, especially if they are paying out of pocket. They want something for their time and money. Clinics also worry about negative ratings on Yelp or Google. All doctors should strive to be good antibiotic stewards, but it's hard when patients have different expectations. This is another reason to stick with your primary care doctor as much as possible. Someone who knows you, whom you trust, can be extremely helpful in figuring out what is best for you or your kids. Can you reach your kids' doctor after hours for advice? My patients and their parents can reach me.