A new The Health of America report from the Blue Cross Blue Shield Association shows that Massachusetts and the nation have made significant progress in reducing the number of outpatient antibiotic prescriptions filled. Reducing inappropriate use and overuse of antibiotics is critical to stemming the increase in antibiotic resistance, which the CDC calls one of the world's most pressing public health issues.
Massachusetts fared better than the national average in two key measures. Prescription fill rates for antibiotics in general are down 11% in Massachusetts, compared to a 9% decrease nationally. Fill rates for broad-spectrum antibiotics, used to treat a wide range of bacteria and most likely to trigger the development of antibiotic-resistant strains, were down 15% in Massachusetts, compared to a 13% drop across the country.
The study also found a significant reduction within the pediatric population, where rates of antibiotic use are typically high. Antibiotic prescriptions filled for children decreased by 13% in Massachusetts and 16% nationally. The steepest decline was among infants, with a national decrease of 22%.
The report, "Antibiotic Prescription Fill Rates Declining in the U.S.," represents a comprehensive study of outpatient medical claims from commercially insured Blue Cross Blue Shield members who filled antibiotic prescriptions between 2010 and 2016. Other notable findings:
Despite the overall improvement, there is still work to be done. In more than 20% of cases, physicians prescribed antibiotics for common, non-bacterial conditions for which antibiotics are generally not an effective treatment. These conditions include flu, viral bronchitis, allergies and viral upper respiratory infections.
The fill rate for reserved antibiotics increased by 30%. These antibiotics, often referred to as "last resort" drugs, are more powerful and should only be used for bacteria that have developed resistance to other antibiotics. Conditions that typically require reserved antibiotics include resistant skin infections caused by methicillin-resistant staphylococcus aureus (MRSA).
There is a wide regional variation in the antibiotic prescription fill rates – Mississippi and Alabama have the highest fill rates, nearly three times greater than those in the lowest states of Hawaii, Oregon and Montana.
While Massachusetts does outperform the national average, there is regional variation within our state. On Cape Cod, there was a slight increase in overall antibiotic prescription fill rates (up 2%), while the fill rate for broad-spectrum antibiotics decreased 13%. Below is a chart showing antibiotic fill rates for four Metropolitan Statistical Areas (MSA) in Massachusetts.