High rates of inappropriate antibiotic use in the outpatient setting

1. The annual antibiotic prescription rate in 2010-2011 was 506 per 1000 population, with only 353 estimated to be appropriate.

2. The diagnoses associated with the highest rates of antibiotic prescription were sinusitis, suppurative otitis media and pharyngitis.

Evidence Rating Level: 2 (Good)

Study Rundown: Antibiotic-resistant pathogens are on the rise and are a great cause of morbidity and mortality. The primary driver of antibiotic resistance is antibiotic use. Thus, the purpose of this study was to determine the rate of outpatient, oral antibiotic prescriptions by age and diagnosis, and to determine the rate of appropriate prescriptions. By utilizing a national database with over 180 000 visits, the authors determined that 12.6% of visits resulted in prescriptions. The most common diagnoses were sinusitis, suppurative otitis media and pharyngitis. Among all conditions and ages, 506 antibiotic prescriptions were written annually per 1000 population, with 353 of these thought to be appropriate prescriptions.

Overall, this study supports the need for increased antibiotic stewardship efforts. The study benefited from using a large national database that is generalizable to various geographic areas and medical specialties. However, data in the database was cataloged as visits and not episodes of illness. Multiple prescriptions for a single person was often captured separately and thus may have overestimated the prevalence of inappropriate prescribing.

Click to read the study in JAMA

Relevant Reading: Recent trends in outpatient antibiotic use in children.

In-Depth [cross-sectional study]: This study utilized the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey from 2010-2011 to estimate the rate of antibiotic prescriptions by region and diagnosis, and also the total and appropriate rates of prescriptions. Of 184 032 visits, 12.6% of visits (95%CI 12-13.3%) resulted in antibiotic prescriptions. The most common diagnoses were sinusitis with 56 prescriptions per 1000 population (95%CI 48-64), suppurative otitis media with 47 prescriptions (95%CI 41-54), and pharyngitis with 43 prescriptions (95%CI 38-49). Among all conditions and ages, 506 antibiotic prescriptions (95%CI 458-554) were written annually per 1000 population, with 353 of these thought to be appropriate prescriptions. Specifically for acute respiratory conditions, 221 prescriptions (95%CI 198-245) were written annually but only 111 were found to be appropriate.

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