Outpatient antibiotic prescribing among Utah Medicaid recipients: A 4-year population-based analysis

Inappropriate antibiotic use can accelerate the evolution and spread of antimicrobial resistance and increase Clostridioides difficile infection and adverse drug events. Utah typically reports lower overall outpatient antibiotic prescribing than the average across the US, but Medicaid-specific trends are less well described.

We conducted a retrospective analysis of Utah Medicaid outpatient pharmacy claims (January 2019-July 2023). Prescription rates were calculated per 1,000 enrollees and compared with all Utah and US rates. Demographics, provider types, age distribution, and antibiotic classes were summarized.

Among 256,602 unique Medicaid patients, 1,812,796 antibiotic claims were identified; 93% were oral agents; mean age at fill was 29.6 years; 57% male. Crude rates fell 55% over the study period (2019 peak 137/1,000; 2020 78/1,000) but remained higher than Utah overall and US comparators. Pediatric and young-adult groups accounted for the largest proportion of prescriptions. Salt Lake County accounted for the majority of prescribing providers, and physicians, nurse practitioners, and physician assistants (NPs/PAs) represented the dominant prescriber types. The most commonly prescribed antibiotic classes were penicillins, cephalosporins, sulfonamides, and tetracyclines.

Outpatient antibiotic prescribing among Utah Medicaid beneficiaries decreased substantially during 2019-2023 but remained elevated compared with statewide and national prescribing rates. Targeted stewardship efforts focused on pediatric and young populations, high-volume prescribers, and geographic areas with higher prescribing rates may help reduce unnecessary antibiotic use in Medicaid populations.