Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011
- PMID: 27139059
- DOI: 10.1001/jama.2016.4151
Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011
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.
Comment in
-
Addressing the Appropriateness of Outpatient Antibiotic Prescribing in the United States: An Important First Step.JAMA. 2016 May 3;315(17):1839-41. doi: 10.1001/jama.2016.4286. JAMA. 2016. PMID: 27139055 No abstract available.
Similar articles
-
Novel approaches to decrease inappropriate ambulatory antibiotic use.Expert Rev Anti Infect Ther. 2019 Jul;17(7):511-521. doi: 10.1080/14787210.2019.1635455. Epub 2019 Jul 5. Expert Rev Anti Infect Ther. 2019. PMID: 31232615 Review.
-
Variability in Antibiotic Prescribing for Upper Respiratory Illnesses by Provider Specialty.J Pediatr. 2018 Dec;203:76-85.e8. doi: 10.1016/j.jpeds.2018.07.044. Epub 2018 Sep 5. J Pediatr. 2018. PMID: 30195553
-
How to avoid the inappropriate use of antibiotics in upper respiratory tract infections? A position statement from an expert panel.Braz J Otorhinolaryngol. 2018 May-Jun;84(3):265-279. doi: 10.1016/j.bjorl.2018.02.001. Epub 2018 Feb 25. Braz J Otorhinolaryngol. 2018. PMID: 29588108 Free PMC article. Review.
-
Recent trends in antibiotic prescriptions for acute respiratory tract infections in pediatric ambulatory care in Taiwan, 2000-2009: A nationwide population-based study.J Microbiol Immunol Infect. 2016 Aug;49(4):554-60. doi: 10.1016/j.jmii.2014.08.014. Epub 2014 Nov 1. J Microbiol Immunol Infect. 2016. PMID: 25442862
-
Antibiotic prescribing for adults with colds, upper respiratory tract infections, and bronchitis by ambulatory care physicians.JAMA. 1997 Sep 17;278(11):901-4. JAMA. 1997. PMID: 9302241
Cited by
-
Association between exposure to antibiotics during pregnancy or early infancy and risk of autism spectrum disorder, intellectual disorder, language disorder, and epilepsy in children: population based cohort study.BMJ. 2024 May 22;385:e076885. doi: 10.1136/bmj-2023-076885. BMJ. 2024. PMID: 38777351 Free PMC article.
-
Rapid respiratory microbiological point-of-care-testing and antibiotic prescribing in primary care: Protocol for the RAPID-TEST randomised controlled trial.PLoS One. 2024 May 20;19(5):e0302302. doi: 10.1371/journal.pone.0302302. eCollection 2024. PLoS One. 2024. PMID: 38768129 Free PMC article. Clinical Trial.
-
Determinants of appropriate antibiotic and NSAID prescribing in unscheduled outpatient settings in the veterans health administration.BMC Health Serv Res. 2024 May 18;24(1):640. doi: 10.1186/s12913-024-11082-0. BMC Health Serv Res. 2024. PMID: 38760660 Free PMC article.
-
Antibiotic appropriateness at outpatient settings in Ethiopia: the need for an antibiotic stewardship programme.Drugs Context. 2024 May 9;13:2023-12-2. doi: 10.7573/dic.2023-12-2. eCollection 2024. Drugs Context. 2024. PMID: 38742144 Free PMC article.
-
Paediatric antibiotic prescribing in a nationwide direct-to-consumer telemedicine platform in France, 2018-2021.JAC Antimicrob Resist. 2024 May 8;6(3):dlae070. doi: 10.1093/jacamr/dlae070. eCollection 2024 Jun. JAC Antimicrob Resist. 2024. PMID: 38721410 Free PMC article.
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical