Outpatient antibiotic prescribing in the United States: 2000 to 2010

Abstract

BackgroundThe use of antibiotics is the single most important driver in antibiotic resistance. Nevertheless, antibiotic overuse remains common. Decline in antibiotic prescribing in the United States coincided with the launch of national educational campaigns in the 1990s and other interventions, including the introduction of routine infant immunizations with the pneumococcal conjugate vaccine (PCV-7); however, it is unknown if these trends have been sustained through recent measurements.MethodsWe performed an analysis of nationally representative data from the Medical Expenditure Panel Surveys from 2000 to 2010. Trends in population-based prescribing were examined for overall antibiotics, broad-spectrum antibiotics, antibiotics for acute respiratory tract infections (ARTIs) and antibiotics prescribed during ARTI visits. Rates were reported for three age groups: children and adolescents (<18 years), adults (18 to 64 years), and older adults (≥65 years).ResultsAn estimated 1.4 billion antibiotics were dispensed over the study period. Overall antibiotic prescribing decreased 18% (risk ratio (RR) 0.82, 95% confidence interval (95% CI) 0.72 to 0.94) among children and adolescents, remained unchanged for adults, and increased 30% (1.30, 1.14 to 1.49) among older adults. Rates of broad-spectrum antibiotic prescriptions doubled from 2000 to 2010 (2.11, 1.81 to 2.47). Proportions of broad-spectrum antibiotic prescribing increased across all age groups: 79% (1.79, 1.52 to 2.11) for children and adolescents, 143% (2.43, 2.07 to 2.86) for adults and 68% (1.68, 1.45 to 1.94) for older adults. ARTI antibiotic prescribing decreased 57% (0.43, 0.35 to 0.52) among children and adolescents and 38% (0.62, 0.48 to 0.80) among adults; however, it remained unchanged among older adults. While the number of ARTI visits declined by 19%, patients with ARTI visits were more likely to receive an antibiotic (73% versus 64%; P <0.001) in 2010 than in 2000.ConclusionsAntibiotic use has decreased among children and adolescents, but has increased for older adults. Broad-spectrum antibiotic prescribing continues to be on the rise. Public policy initiatives to promote the judicious use of antibiotics should continue and programs targeting older adults should be developed.

A decade of outpatient antimicrobial use in older adults in Ontario: a descriptive study

“…1,5,20 This highlights the potential impact a community-based antimicrobial stewardship program could have in reducing overall antibiotic use.…”

“…These results diverge from the rise in use of broad-spectrum antibiotics reported in prior studies. 2,5,20 This may represent a positive change, with physicians favouring narrow-spectrum agents where appropriate. However, overall outpatient antibiotic use was consistent over our study period, averaging 25.1 defined daily doses per 1000 person-days per year, with 40.7% of older adults receiving a prescription.…”

What Drives Variation in Antibiotic Prescribing for Acute Respiratory Infections?

“…1,2 There has been some progress. Numerous interventions have been tried over the last several decades ranging from physician education to the CDC's GET SMART patient education campaign.…”

Broad-Spectrum Antibiotic Abuse and its Connection to Obesity

“…In 2002, the number of narrow-spectrum antibiotics prescribed increased to 63,428 and broad-spectrum antibiotic prescriptions to 13 million [20,21]. This increase in broad-spectrum antibiotics has not slowed, as broad-spectrum antibiotic prescriptions have doubled from 2000 to 2010 [22]. In addition, it was recently discovered that at least 1 in 3 antibiotic prescriptions in the United States are unnecessary, and antibiotics are often deployed to treat viral infections [23].…”