A study of emergency and family medicine providers in Washington state found an association between high antibiotic and high opioid prescribing rates, researchers reported today in Open Forum Infectious Diseases.

Using data from the Centers for Medicare & Medicaid Services Medicare Part D (MPD) program for 2021, researchers from the Washington State Department of Health looked at outpatient prescriptions at the prescriber level for three categories of drugs (antibiotics, antipsychotics, and opioids) and provider details such as provider type, sex, and practice location. They defined high prescribing behavior as a prescribing rate greater than or equal to the 90th percentile of their specialty and used multivariate logistic regression to determine associations between high antibiotic and high opioid prescribers.

Antibiotic, opioid stewards could learn from each other

A total of 2,766 family and emergency medicine physicians prescribed both opioids and antibiotics to MPD beneficiaries in 2021. The median prescribing rate for antibiotics was 212 antibiotic claims per 1,000 beneficiaries, and the median prescribing rate for opioids was 328 opioid claims per 1,000 beneficiaries. Three hundred and eight physicians (11%) were identified as high prescribers of antibiotics, and 244 physicians (9%) were identified as high prescribers of opioids.

After adjustment for physician age and sex, the overall odds of being a high antibiotic prescriber were 2.91 times (95% confidence interval [CI], 2.10 to 4.0) greater among physicians who were also high prescribers of opioids, and the odds of being a high opioid prescriber were 2.90 times (95% CI, 2.09 to 3.09) greater among physicians who were high antibiotic prescribers. The researchers also found that the odds of being a high prescriber of both medications increased with the age of the physician.

The authors of the study say the findings suggest that high prescribing of medications is a provider behavior, and that opioid and antimicrobial stewards should collaborate on shared goals.

"Opportunities exist for stewards in both disciplines to learn from each other such as uptake of clinical decision support tools to optimize prescribing, shorter drug durations for acute conditions, optimizing discharge prescribing, and communication strategies regarding benefits and risks of drugs and contingency planning," they wrote.

The UK Health Security Agency (HSA) yesterday announced two more clade 1b mpox cases, both of them contacts of the country's first imported case.

In a statement, the HSA said both patients are receiving care in London at Guy's and St Thomas' National Health Service Foundation Trust.

Susan Hopkins, MB BCh, the HAS's chief medical adviser, said, "Mpox is very infectious in households with close contact and so it is not unexpected to see further cases within the same household." She added that the overall risk to the UK population remains low.

The country reported its first clade 1b case on October 30 in a person in London who had recently traveled to countries in Africa where the virus is spreading. The United Kingdom was the fifth country outside of Africa to report an imported case of clade 1b mpox, which is different from the clade 2 virus spreading globally.

Mpox is very infectious in households with close contact.

The novel clade 1b virus was first detected in April amid a large outbreak under way in the Democratic Republic of the Congo (DRC). It is circulating among other mpox clades in the DRC and some of its neighbors, such as Uganda and Burundi. 

Vaccination and other interventions to prevent respiratory syncytial virus (RSV) infection could help reduce antibiotic prescribing and help decrease antibiotic resistance, researchers from the United Kingdom reported yesterday in a preprint study.

A research team from the UK Health Security Agency (HSA), Imperial College London, and Oxford University looked at general practice antibiotic prescribing data and lab-confirmed respiratory infections from 2015 to 2018 to tease out the proportion of antibiotic prescriptions doctors were writing for RSV infections. 

They found that about 2.1% of antibiotic prescriptions over that period were connected to RSV diagnosis, with the largest number in people older than 75 and the highest prescribing rate in infants. 

Role of vaccines in curbing antibiotic use

Ceire Costelloe, PhD, a visiting professor of health informatics at Imperial College London, said in an HSA press release that the study is the first estimate of RSV-attributable primary care antibiotic prescriptions by antibiotic class using a nationally representative surveillance data. "Importantly, our study suggests that interventions to reduce the burden of RSV infections in England, such as vaccines, could complement current strategies to reduce antibiotic use nationally."

The United Kingdom launched an RSV vaccination program in September, offering the shot to seniors ages 75 to 79 and to pregnant women once they reach 28 weeks gestation. Health officials estimate that the vaccine campaign could avert 70,000 RSV infections in babies younger than 12 months and 60,000 fewer illnesses in older adults.

Hunter-harvested animals in Wyoming's Deer Hunt Areas 31 and 94 and Elk Hunt Area 126 have tested positive for chronic wasting disease (CWD) for the first time, the Wyoming Game and Fish Department confirmed yesterday.

Deer Hunt Area 31 is located in the Sheridan region, which is bordered by five areas positive for CWD in mule deer (29, 19, 22, 34, and 169). Deer Hunt Area 94, in the Lander region, is bordered by areas 92, 160, 97, 96, and 131, which have also had detections in mule deer. The Casper region is home to Elk Hunt Area 126, which is bordered by seven CWD-positive elk areas (3, 7, 122, 129, 113, 123, and 117).

The news release gave no information on the number of CWD-positive cervids identified in the latest detections.

"In 2023, Game and Fish personnel tested more than 5,000 CWD lymph node samples from deer and elk—primarily submitted by hunters—and continue to evaluate new recommendations for trying to manage the disease," the news release said.

Officials caution against eating meat from infected, sick cervids

CWD is a fatal neurodegenerative disease in cervids caused called by extremely resilient misfolded proteins called prions, which can be transmitted among cervids and through environmental contamination. 

In 2023, Game and Fish personnel tested more than 5,000 CWD lymph node samples from deer and elk—primarily submitted by hunters—and continue to evaluate new recommendations for trying to manage the disease.

While CWD isn't known to infect people, the World Health Organization and the US Centers for Disease Control and Prevention recommend against eating meat from an infected animal and urge taking precautions when field-dressing or butchering cervids.