Antibiotic prescribing for acute gastroenteritis during ambulatory care visits-United States, 2006-2015
Jennifer P Collins1,2, Laura M King3, Sarah A Collier4
1Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Insights
Approximately 13% of acute gastroenteritis (AGE) cases received antibiotic prescriptions, often unnecessarily for viral infections. Improved antibiotic stewardship is crucial for managing AGE in outpatient settings.
Area of Science:
- Public Health
- Infectious Diseases
- Pharmacology
Background:
- Antibiotic prescribing for acute gastroenteritis (AGE) varies.
- Understanding national prescribing patterns is essential for antimicrobial stewardship.
Purpose of the Study:
- To describe national antibiotic prescribing trends for acute gastroenteritis (AGE).
- To identify patterns of antibiotic use in ambulatory care settings for AGE.
Main Methods:
- Analysis of data from the National Ambulatory Medical Care Survey/National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS) (2006-2015) and IBM Watson MarketScan database.
- Calculation of antibiotic prescription rates for AGE visits, with breakdowns by pathogen where data allowed.
- Use of Poisson regression for MarketScan data to determine antibiotic prescribing percentages and confidence intervals.
Main Results:
- An estimated 13.3% of AGE visits in NAMCS/NHAMCS and 13.8% in MarketScan resulted in antibiotic prescriptions.
- Commonly prescribed antibiotics included fluoroquinolones, nitroimidazoles, and penicillins.
- Antibiotics were prescribed for viral gastroenteritis in 12.3% of cases and for specific bacterial infections where not recommended.
Conclusions:
- Around 13% of AGE visits led to antibiotic prescriptions.
- Unnecessary antibiotic prescribing occurred for viral gastroenteritis and certain bacterial infections.
- There is a need for enhanced antibiotic stewardship interventions for AGE in ambulatory care.
Objective:
To describe national antibiotic prescribing for acute gastroenteritis (AGE).
Setting:
Ambulatory care.
Methods:
We included visits with diagnoses for bacterial and viral gastrointestinal infections from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS; 2006-2015) and the IBM Watson 2014 MarketScan Commercial Claims and Encounters Database. For NAMCS/NHAMCS, we calculated annual percentage estimates and 99% confidence intervals (CIs) of visits with antibiotics prescribed; sample sizes were too small to calculate estimates by pathogen. For MarketScan, we used Poisson regression to calculate the percentage of visits with antibiotics prescribed and 95% CIs, including by pathogen.
Results:
We included 10,210 NAMCS/NHAMCS AGE visits; an estimated 13.3% (99% CI, 11.2%-15.4%) resulted in antibiotic prescriptions, most frequently fluoroquinolones (28.7%; 99% CI, 21.1%-36.3%), nitroimidazoles (20.2%; 99% CI, 14.0%-26.4%), and penicillins (18.9%; 99% CI, 11.6%-26.2%). In NAMCS/NHAMCS, antibiotic prescribing was least frequent in emergency departments (10.8%; 99% CI, 9.5%-12.1%). Among 1,868,465 MarketScan AGE visits, antibiotics were prescribed for 13.8% (95% CI, 13.7%-13.8%), most commonly for Yersinia (46.7%; 95% CI, 21.4%-71.9%), Campylobacter (44.8%; 95% CI, 41.5%-48.1%), Shigella (39.7%; 95% CI, 35.9%-43.6%), typhoid or paratyphoid fever (32.7%; (95% CI, 27.2%-38.3%), and nontyphoidal Salmonella (31.7%; 95% CI, 29.5%-33.9%). Antibiotics were prescribed for 12.3% (95% CI, 11.7%-13.0%) of visits for viral gastroenteritis.
Conclusions:
Overall, ∼13% of AGE visits resulted in antibiotic prescriptions. Antibiotics were unnecessarily prescribed for viral gastroenteritis and some bacterial infections for which antibiotics are not recommended. Antibiotic stewardship assessments and interventions for AGE are needed in ambulatory settings.
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