Antibiotic abuse and overuse gravely endanger world health by creating bacteria resistant to these necessary drugs, an issue particularly serious because healthcare infrastructure in low- and middle-income countries (LMICs) sometimes lacks the institutional framework to effectively administer and track antibiotic prescriptions.

Doctors at Michigan Medicine at the University of Michigan recently conducted research, highlighting the need for urgent clinics and emergency rooms to improve their medical record-keeping in order to address this growing risk.

According to two new peer-reviewed studies, a large number of patients receiving antibiotics in clinics and emergency rooms lack a diagnosis or recorded symptoms to back up the prescription.

The inadequate documentation hinders efforts to optimise antibiotic use and reduce the risk of resistance.

According to one study, 10% of toddlers and 35% of adults received antibiotic prescriptions during office visits without any specific explanation.

 For individuals receiving care in clinics and emergency rooms, the issue is rather prevalent, particularly for Medicaid or uninsured patients, along with children,.

Since there is no information available on the basis for these unnecessary prescriptions, clinics, hospitals, and health insurers find it challenging to implement procedures that ensure antibiotics are given only when absolutely necessary.

Abuse of antibiotics increases the risk of bacterial resistance, which eventually lowers the efficacy of the drugs for all patients and giving patients antibiotics incorrectly may sometimes do more harm than good.

The first author of both studies, Dr. Joseph Ladines-Lim, a combination internal medicine and paediatrics resident at Michigan Medicine, emphasised the need for accurate record-keeping.

"It becomes difficult to estimate how many of those prescriptions are truly inappropriate and to focus on reducing inappropriate prescribing when clinicians don't record why they are prescribing antibiotics," he said.

Ladines-Lim and his colleague, U-M paediatrician and healthcare researcher Dr. Kao-Ping Chua, conducted the experiments, published in the Journal of General Internal Medicine published their findings in Antimicrobial Stewardship and Healthcare Epidemiology, building on previous research showing that more than 25% of antibiotic prescriptions for outpatients are unnecessary.

This includes prescriptions for conditions that antibiotics cannot cure, such as colds, as well as those unrelated to any valid antibiotic use diagnosis.

The most recent studies, which examine two groups of incorrect prescriptions—those for infectious conditions inappropriate for antibiotics and those without any related symptoms or diagnosis—offer more nuance.

Although the present analysis reveals that the latter also accounts for a significant portion of antibiotic prescriptions, the former has received much attention in attempts to reduce inaccurate prescriptions.

Clinicians writing antibiotic prescriptions do not always need to list specific diagnoses or conduct tests to confirm bacterial illnesses.

Sometimes only symptoms will lead to a prescription, which could lead to an overprescription or a misdiagnosis.

As a result, when some people receive antibiotics for conditions they do not have, the possibility of resistance increases.

The lack of institutional support and resources for appropriate record-keeping exacerbates the situation in LMICs, where the healthcare infrastructure is typically insufficient.

Increased inappropriate or unreported antibiotic prescriptions may, in turn, worsen antibiotic resistance.

The researchers think that the decreased diagnosis documentation rate among individuals in the healthcare safety net may be connected to reimbursement procedures.

In contrast to commercially insured clients who receive care on a fee-for-service basis, Medicaid frequently pays clinics and hospitals predetermined sums to care for all individuals with that type of coverage.

"This might actually be a matter of health equity if people with low incomes or no insurance are being treated differently when it comes to antibiotics," Ladines-Lim added.

Public and private insurers, as well as health systems, should provide incentives for accurate diagnosis and coding of antibiotic prescriptions.

This could include requiring doctors to record the reason for prescribing antibiotics before allowing electronic health record systems to send prescriptions to pharmacies.

Given the threat that antibiotic resistance poses to the world, action to protect antibiotic prescriptions is imperative.

Correct documentation of antibiotic prescriptions may lower the risk of resistance, just as diagnoses are required to support procedures like CT scans and x-rays.

The study by Ladines-Lim, Chua, and colleagues—Michael A. Fischer of Boston Medical Centre and Jeffrey A. Linder of Northwestern University, for example—highlights the urgent need for systemic changes to improve antibiotic stewardship, particularly in low-income countries (LMICs) with potentially inadequate healthcare infrastructure.

Better medical record-keeping and accurate diagnosis coding will help healthcare systems everywhere combat the expanding issue of antibiotic resistance.