TY - JOUR
T1 - Prevalence of inappropriate antibiotic prescriptions among us ambulatory care visits, 2010-2011
AU - Fleming-Dutra, Katherine E.
AU - Hersh, Adam L.
AU - Shapiro, Daniel J.
AU - Bartoces, Monina
AU - Enns, Eva A.
AU - File, Thomas M.
AU - Finkelstein, Jonathan A.
AU - Gerber, Jeffrey S.
AU - Hyun, David Y.
AU - Linder, Jeffrey A.
AU - Lynfield, Ruth
AU - Margolis, David J.
AU - May, Larissa S.
AU - Merenstein, Daniel
AU - Metlay, Joshua P.
AU - Newland, Jason G.
AU - Piccirillo, Jay F.
AU - Roberts, Rebecca M.
AU - Sanchez, Guillermo V.
AU - Suda, Katie J.
AU - Thomas, Ann
AU - Woo, Teri Moser
AU - Zetts, Rachel M.
AU - Hicks, Lauri A.
N1 - Funding Information:
This project was made possible through a partnership with the Centers for Disease Control and Prevention (CDC) Foundation. Support for this project was provided by Pew Charitable Trusts.
Publisher Copyright:
© 2016 American Medical Association. All rights reserved.
PY - 2016/5/3
Y1 - 2016/5/3
N2 - 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.
AB - 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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U2 - 10.1001/jama.2016.4151
DO - 10.1001/jama.2016.4151
M3 - Article
C2 - 27139059
AN - SCOPUS:84971655200
SN - 0098-7484
VL - 315
SP - 1864
EP - 1873
JO - JAMA - Journal of the American Medical Association
JF - JAMA - Journal of the American Medical Association
IS - 17
ER -