Katherine E Fleming-Dutra1, Adam L Hersh2, Daniel J Shapiro3, Monina Bartoces1, Eva A Enns4, Thomas M File5, Jonathan A Finkelstein6, Jeffrey S Gerber7, David Y Hyun8, Jeffrey A Linder9, Ruth Lynfield10, David J Margolis11, Larissa S May12, Daniel Merenstein13, Joshua P Metlay14, Jason G Newland15, Jay F Piccirillo16, Rebecca M Roberts1, Guillermo V Sanchez1, Katie J Suda17, Ann Thomas18, Teri Moser Woo19, Rachel M Zetts8, Lauri A Hicks1. 1. Centers for Disease Control and Prevention, Atlanta, Georgia. 2. Pediatric Infectious Diseases, University of Utah, Salt Lake City. 3. School of Medicine, University of California, San Francisco, San Francisco. 4. Division of Health Policy and Management, University of Minnesota, Minneapolis. 5. Summa Health System and Northeast Ohio Medical University, Akron. 6. Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts. 7. Children's Hospital of Philadelphia, Philadelphia, Pennsylvania8University of Pennsylvania Perelman School of Medicine, Philadelphia. 8. Pew Charitable Trusts, Washington, DC. 9. Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts. 10. Minnesota Department of Health, St Paul. 11. University of Pennsylvania Perelman School of Medicine, Philadelphia. 12. Department of Emergency Medicine, University of California-Davis, Sacramento. 13. Department of Family Medicine, Georgetown University Medical Center, Washington, DC. 14. Division of General Internal Medicine, Massachusetts General Hospital, Boston. 15. Division of Pediatric Infectious Diseases, Washington University School of Medicine, St Louis, Missouri. 16. Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri. 17. Department of Veterans Affairs, University of Illinois at Chicago, Chicago. 18. Oregon Public Health Division, Portland. 19. Pacific Lutheran University, Tacoma, Washington.
Abstract
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.
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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