National Trends in Oral Antibiotic Prescribing in United States Physician Offices from 2009 to 2016.

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Eric H Young, Rupesh M Panchal, Alexander G Yap, Kelly R Reveles

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Eric H Young: College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA.
Rupesh M Panchal: College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA.
Alexander G Yap: College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA.
Kelly R Reveles: College of Pharmacy, The University of Texas at Austin, Austin, Texas, USA. ORCID

PMID: 32867003 DOI: 10.1002/phar.2456

BACKGROUND: Prior studies have found that outpatient antibiotics are commonly prescribed for non-bacterial conditions. It is unclear if national prescribing has changed in recent years given recent public health and antimicrobial stewardship initiatives. This study aimed to describe antibiotic prescribing in United States (U.S.) physician offices.
MATERIALS/METHODS: This was a cross-sectional study of all sampled patient visits in the Centers for Disease Control and Prevention's National Ambulatory Medical Care Survey from 2009 to 2016. Antibiotic use was defined as at least one oral antibiotic prescription during the visit as identified by Multum code(s). Patient visits were categorized by U.S. geographic region and season. ICD-9-CM and ICD-10 codes were used to assess diagnoses and categorize antibiotic use as appropriate, possibly appropriate, or inappropriate.
RESULTS: Seven billion visits were included for analysis, with 793,415,182 (11.3%) including an antibiotic. Prescribing rates were relatively stable over the study period (102.9-124.9 prescriptions per 1000 visits); however, 2016 had one of the lowest prescribing rates (107.7 per 1000 visits). The most commonly prescribed antibiotic class was macrolides (25 per 1000 visits). The South region and winter season had the highest antibiotic prescribing (118.2 and 129.7 per 1000 visits, respectively). Of patients who received an antibiotic, 55.9%, 35.7%, and 8.4% were classified as inappropriate, possibly appropriate, and appropriate, respectively. The most common conditions in which antibiotics were prescribed inappropriately included those with no indication in any of the predefined diagnosis codes (40.1%), other skin conditions (17.3%), and viral upper respiratory conditions (13.3%).
CONCLUSIONS: There was no significant reduction in outpatient antibiotic prescribing rates among U.S. outpatients from 2009 to 2016 and prescribing varied by region and season. These data suggest that more than half of antibiotics were prescribed inappropriately, with the majority of antibiotics prescribed with no indication. However, these findings need to be confirmed with robust prospective studies.

antibiotics outpatient prescribing stewardship trends

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Administration, Oral

Adolescent

Adult

Aged

Anti-Bacterial Agents

Antimicrobial Stewardship

Cross-Sectional Studies

Female

Health Care Surveys

Humans

Inappropriate Prescribing

Male

Middle Aged

Practice Patterns, Physicians'

United States

Young Adult

Anti-Bacterial Agents

Journal Article

Antibiotic Prescribing in Adults Presenting with Pharyngitis Pre- and Post-Implementation of a Rapid Group A Streptococcus Test.Antibiotic exposure and acquisition of antibiotic-resistant gram-negative bacteria among outpatients at a US Veterans Affairs medical center.Efficacy of priming and commitment posters on urgent care patients' antibiotic expectations and knowledge: a cluster randomized trial.National Disparities in Antibiotic Prescribing by Race, Ethnicity, Age Group, and Sex in United States Ambulatory Care Visits, 2009 to 2016.Long-Term Outcomes of a Health Information System-Based Feedback Intervention Study of Antimicrobial Prescriptions in Primary Care Institutions: Follow-Up of a Randomized Cross-Over Controlled Trial.Non-Visit-Based and Non-Infection-Related Antibiotic Use in the US: A Cohort Study of Privately Insured Patients During 2016-2018.Consumption Trends of Antibiotics in Brazil During the COVID-19 Pandemic.Trends and Patterns of Antibiotic Prescriptions in Primary Care Institutions in Southwest China, 2017-2022.

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