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Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011
Katherine E Fleming-Dutra1, Adam L Hersh2, Daniel J Shapiro3
1Centers for Disease Control and Prevention, Atlanta, Georgia.
Insights
In the US, 506 antibiotic prescriptions were written annually per 1000 people, but only 353 were appropriate, highlighting the need for antibiotic stewardship to combat resistance.
Area of Science:
- Public Health
- Infectious Diseases
- Pharmacology
Background:
- The National Action Plan for Combating Antibiotic-Resistant Bacteria aimed to halve inappropriate outpatient antibiotic use by 2020.
- The precise extent of inappropriate outpatient antibiotic prescribing remains largely unknown.
Purpose of the Study:
- To estimate outpatient oral antibiotic prescribing rates by age and diagnosis in the US.
- To determine the proportion of antibiotic use that may be inappropriate in adults and children.
Main Methods:
- Analysis of the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data.
- Estimation of annual population-adjusted rates of ambulatory visits with oral antibiotic prescriptions.
- Determination of diagnosis-specific rates of appropriate antibiotic prescriptions based on national guidelines.
Main Results:
- Approximately 12.6% of sampled ambulatory visits resulted in an antibiotic prescription.
- Sinusitis, suppurative otitis media, and pharyngitis were the top diagnoses for antibiotic prescriptions.
- An estimated 506 antibiotic prescriptions per 1000 population were written annually, with only 353 deemed appropriate.
Conclusions:
- Significant opportunities exist for improving antibiotic stewardship in US outpatient settings.
- The findings underscore the necessity of establishing clear goals for reducing inappropriate antibiotic prescribing.
- Addressing inappropriate antibiotic use is crucial for combating the growing threat of antibiotic resistance.
Importance:
The National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal of reducing inappropriate outpatient antibiotic use by 50% by 2020, but the extent of inappropriate outpatient antibiotic use is unknown.
Objective:
To estimate the rates of outpatient oral antibiotic prescribing by age and diagnosis, and the estimated portions of antibiotic use that may be inappropriate in adults and children in the United States.
Design, Setting, And Participants:
Using the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, annual numbers and population-adjusted rates with 95% confidence intervals of ambulatory visits with oral antibiotic prescriptions by age, region, and diagnosis in the United States were estimated.
Exposures:
Ambulatory care visits.
Main Outcomes And Measures:
Based on national guidelines and regional variation in prescribing, diagnosis-specific prevalence and rates of total and appropriate antibiotic prescriptions were determined. These rates were combined to calculate an estimate of the appropriate annual rate of antibiotic prescriptions per 1000 population.
Results:
Of the 184,032 sampled visits, 12.6% of visits (95% CI, 12.0%-13.3%) resulted in antibiotic prescriptions. Sinusitis was the single diagnosis associated with the most antibiotic prescriptions per 1000 population (56 antibiotic prescriptions [95% CI, 48-64]), followed by suppurative otitis media (47 antibiotic prescriptions [95% CI, 41-54]), and pharyngitis (43 antibiotic prescriptions [95% CI, 38-49]). Collectively, acute respiratory conditions per 1000 population led to 221 antibiotic prescriptions (95% CI, 198-245) annually, but only 111 antibiotic prescriptions were estimated to be appropriate for these conditions. Per 1000 population, among all conditions and ages combined in 2010-2011, an estimated 506 antibiotic prescriptions (95% CI, 458-554) were written annually, and, of these, 353 antibiotic prescriptions were estimated to be appropriate antibiotic prescriptions.
Conclusions And Relevance:
In the United States in 2010-2011, there was an estimated annual antibiotic prescription rate per 1000 population of 506, but only an estimated 353 antibiotic prescriptions were likely appropriate, supporting the need for establishing a goal for outpatient antibiotic stewardship.
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