By Marie Rosenthal, MS
More white than Black patients receive antibiotics from their healthcare providers, but this might be one case in which a health inequity actually improves care, because the majority of antibiotics prescribed to outpatients are unnecessary, explained Zanthia Wiley, MD, an associate professor of medicine at Emory University School of Medicine, in Atlanta.
Although all health inequities need to be addressed, Dr. Wiley does not want to see unnecessary and inappropriate antibiotic prescriptions increase among Black patients.
“That’s my worst nightmare to be honest with you,” she said at IDWeek 2022, in Washington, D.C. “I don’t want health equity with respect to antibiotic prescribing [to increase prescribing] because we all know so much of this is inappropriate antibiotic prescribing.”
She wants to see Black patients receive the appropriate antibiotics when they are needed, which is why health inequities need to be addressed, so that all patients receive the best care.
“Study after study has shown this,” Dr. Wiley said. “Overall antibiotic prescribing is less; overall antibiotic prescribing for acute otitis media is less; overall outpatient antibiotic prescribing of broad-spectrum antibiotics is less [for Blacks and other minorities than whites].
“So, this is one of those instances in health equity where being Black may be a bit of an advantage, because as a Black person, evidence shows that I am less likely to be prescribed antibiotics,” she said.
“But the health inequity itself is a problem, and we need to try to get to the root of it,” she said.
The problems of health inequities are multifactorial, she said, but part of it may be an “implicit racial bias in prescribing practices. I really, truly do think it’s implicit. Do I think people walk into a room and see a Black child and say, ‘No, I’m not going to give you antibiotics?’”
She said she doubts that is the case, but physicians need to be aware of the implicit bias occurring in practices across the country. A good place for physicians to start is to find out their prescribing habits as they relate to race and ethnicity. Do their white patients receive more antibiotics than their Black and Hispanic patients? No one has that metric, she said, not even herself.
“As a Black woman who is a stewardship leader and who prescribes antibiotics, had I looked at this? No, I had not,” she said.
“I assume and I hope that my antibiotic prescribing is not different based on the race and ethnicity of my patients, but I have absolutely no clue.”
An issue with studies about inequities of antibiotic prescribing is that many don’t look at the appropriateness of the antibiotic, whether Black patients are receiving appropriate antibiotics when they are needed, and the outcomes are of that inequity if they are not, she said.
There is no quick fix for these inequities of care, but there are some actions that physicians can take today to ensure that everyone receives equal care.
First, make sure that sex (because women are frequently prescribed antibiotics than men), race and ethnicity are included as variables in stewardship intervention programs. This will help start the conversation and develop those metrics about race-based prescribing habits that are sorely needed.
Think about preventive care. Discuss vaccinations with every patient. If they are less likely to get influenza, for instance, because they have received their flu shot, they are less likely to show up in the office and receive an inappropriate antibiotic.
And provide education to patients. Teach patients about when antibiotics are appropriate and when they are not.
“Educating minority communities about antibiotics and the necessity of using them appropriately [is important],” she said. “And I would even say it’s not just important to educate minority communities; it’s important for us to educate all of our patients. Because who is getting the greatest proportion of inappropriate antibiotics? To be honest with you, it is white people.”
