Antibiotic prescribing for adults in ambulatory care in the USA, 2007-09.
ABSTRACT To determine patterns of ambulatory antibiotic prescribing in US adults, including the use of broad-spectrum versus narrow-spectrum agents, to provide a description of the diagnoses for which antibiotics are prescribed and to identify patient and physician factors associated with broad-spectrum antibiotic prescribing.
We used data for patients aged ≥18 years from the National Ambulatory and National Hospital Ambulatory Medical Care Surveys (2007-09). These are nationally representative surveys of patient visits to offices, hospital outpatient departments and emergency departments (EDs) in the USA, collectively referred to as ambulatory visits. We determined the types of antibiotics prescribed, including the use of broad-spectrum versus narrow-spectrum antibiotics, and examined prescribing patterns by diagnoses. We used multivariable logistic regression to identify factors associated with broad-spectrum antibiotic prescribing.
Antibiotics were prescribed during 101 million (95% CI: 91-111 million) ambulatory visits annually, representing 10% of all visits. Broad-spectrum agents were prescribed during 61% of visits in which antibiotics were prescribed. The most commonly prescribed antibiotics were quinolones (25% of antibiotics), macrolides (20%) and aminopenicillins (12%). Antibiotics were most commonly prescribed for respiratory conditions (41% of antibiotics), skin/mucosal conditions (18%) and urinary tract infections (9%). In multivariable analysis, among patients prescribed antibiotics, broad-spectrum agents were more likely to be prescribed than narrow-spectrum antibiotics for respiratory infections for which antibiotics are rarely indicated (e.g. bronchitis), during visits to EDs and for patients ≥60 years.
Broad-spectrum agents constitute the majority of antibiotics in ambulatory care. More than 25% of prescriptions are for conditions for which antibiotics are rarely indicated. Antibiotic stewardship interventions targeting respiratory and non-respiratory conditions are needed in ambulatory care.
- JAMA The Journal of the American Medical Association 07/2003; 289(21):2797; author reply 2797-8. · 29.98 Impact Factor
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ABSTRACT: Several studies have shown that use of medications to treat chronic conditions is highly sensitive to out-of-pocket price and influenced by changes in insurance coverage. Because antibiotics target infections and are used for a short period, one may expect antibiotic use to be less responsive to price. However, no studies have evaluated how antibiotic use changes with drug coverage. We evaluate changes in ambulatory oral antibiotic use after implementation of the Medicare drug benefit (Part D). We conducted a comparison group analysis 2 years before and after implementation of Part D using insurance claims data from a large Medicare Advantage plan (January 1, 2004, through December 31, 2007). Outcomes included the likelihood of using any oral antibiotics and major antibiotic subclasses among 35 102 older adults and rates of antibiotic use among those with pneumonia and other acute respiratory tract infections. Overall antibiotic use increased most among those who did not previously have drug coverage (relative odds ratio [OR], 1.58; 95% confidence interval [CI], 1.36-1.85). Use of the broad spectrum antibiotic subclasses of quinolones (OR, 1.70; 95% CI, 1.35-2.15) and macrolides (1.59; 1.26-2.01) increased more than the use of other subclasses, especially for those with prior drug coverage. Rates of ambulatory antibiotic use associated with pneumonia increased (OR, 3.60; 95% CI, 2.35-5.53) more than those associated with other acute respiratory tract infections (2.29; 1.85-2.83). Antibiotic use increased among older adults whose drug coverage improved after Part D implementation, with the largest increases for broad spectrum, newer, and more expensive antibiotics. Our study suggests reimbursement may play a role in addressing inappropriate antibiotic use.Archives of internal medicine 08/2010; 170(15):1308-14. · 11.46 Impact Factor
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ABSTRACT: Antibiotics are commonly prescribed for children with conditions for which they provide no benefit, including viral respiratory infections. Broad-spectrum antibiotic use is increasing, which adds unnecessary cost and promotes the development of antibiotic resistance. To provide a nationally representative analysis of antibiotic prescribing in ambulatory pediatrics according to antibiotic classes and diagnostic categories and identify factors associated with broad-spectrum antibiotic prescribing. We used the National Ambulatory and National Hospital Ambulatory Medical Care surveys from 2006 to 2008, which are nationally representative samples of ambulatory care visits in the United States. We estimated the percentage of visits for patients younger than 18 years for whom antibiotics were prescribed according to antibiotic classes, those considered broad-spectrum, and diagnostic categories. We used multivariable logistic regression to identify demographic and clinical factors that were independently associated with broad-spectrum antibiotic prescribing. Antibiotics were prescribed during 21% of pediatric ambulatory visits; 50% were broad-spectrum, most commonly macrolides. Respiratory conditions accounted for >70% of visits in which both antibiotics and broad-spectrum antibiotics were prescribed. Twenty-three percent of the visits in which antibiotics were prescribed were for respiratory conditions for which antibiotics are not clearly indicated, which accounts for >10 million visits annually. Factors independently associated with broad-spectrum antibiotic prescribing included respiratory conditions for which antibiotics are not indicated, younger patients, visits in the South, and private insurance. Broad-spectrum antibiotic prescribing in ambulatory pediatrics is extremely common and frequently inappropriate. These findings can inform the development and implementation of antibiotic stewardship efforts in ambulatory care toward the most important geographic regions, diagnostic conditions, and patient populations.PEDIATRICS 11/2011; 128(6):1053-61. · 4.47 Impact Factor