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Invited Commentary
November 2016

Tipping the Balance Toward Fewer Antibiotics

Author Affiliations
  • 1Harvard Medical School, Boston, Massachusetts
  • 2Division of General Internal Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts
  • 3Division of General Internal Medicine and Primary Care, Brigham & Women’s Hospital, Boston, Massachusetts
JAMA Intern Med. 2016;176(11):1649-1650. doi:10.1001/jamainternmed.2016.6254

News of patients with broadly resistant “superbugs” have recently raised public awareness of the risks of antibiotic overuse. But unnecessary antibiotic use is not a new problem; it has been a public health priority for decades and 2 new articles1,2 in the current issue of JAMA Internal Medicine illustrate the persistence of this problem. A number of initiatives have been attempted to address antibiotic overuse, and there was initial success with a roughly 20% reduction in outpatient antibiotic prescribing per capita.3 But those efforts have stalled, rates of outpatient antibiotic prescribing have remained stagnant, and, most troubling, an increasing fraction of prescriptions are for broad-spectrum antibiotics. The reality is that in the outpatient setting at least one-third of all antibiotics are prescribed unnecessarily.4 In hospitals there are similar trends. Baggs and colleagues1 found that the use of antibiotics per hospital day did not change between 2006 and 2012 and that the use of broad-spectrum antibiotics increased.

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