Temporal trends in ambulatory antibiotic prescription rates in South Carolina: Impact of age, gender, and resident location

Abstract

Objective: To examine the temporal trends in ambulatory antibiotic prescription fill rates and to determine the influences of age, gender, and location. Design: Population-based cohort study. Setting: Ambulatory setting in South Carolina. Patients: Patients ≤64 years of age from January 2012 to December 2017. Methods: Aggregated pharmacy claims data for oral antibiotic prescriptions were utilized to estimate community antibiotic prescription rates. Poisson regression or Student t tests were used to examine overall temporal trend in antibiotic prescription rates, seasonal variation, and the trends across age group, gender, and rural versus urban location. Results: Overall antibiotic prescription rates decrease from 1,127 to 897 per 1,000 person years (P < .001). The decrease was more noticeable in persons aged <18 years (26%) and 18–39 years (20%) than in those aged 40–64 years (5%; P < .001 for all). Prescription rates were higher among females than males in all age groups, although this finding was the most pronounced in group aged 18–39 years (1,232 vs 585 per 1,000 person years; P < .0001). Annualized antibiotic prescription rates were higher during the winter months (December–March) than the rest of the year (1,145 vs 885 per 1,000 person years; P < .0001), and rates were higher in rural areas than in urban areas (1,032 vs 941 per 1,000 person years; P < .0001). Conclusions: The decline in ambulatory antibiotic prescription rates is encouraging. Ongoing ambulatory antibiotic stewardship efforts across South Carolina should focus on older adults, rural areas, and during the winter season when antibiotic prescriptions peak.

Temporal Association between Influenza Vaccination Coverage and Ambulatory Antibiotic Use in Children

“…4 The overall rate of antibiotic prescribing in ambulatory settings is declining in children as evidenced by recent studies. 2,3,9 Some of this national decline is attributable to reductions in prescribing for acute respiratory conditions of viral origin through educational campaigns of the general public and health care providers, CDC's Get Smart campaign, stricter diagnostic criteria for ARTI, and watchful waiting for nonsevere otitis media in selected children. 4,10 There have been other studies assessing educational interventions combined with quarterly individualized antibiotic prescribing feedback resulting in reduced broad-spectrum antibiotic prescribing for patients with pneumonia and sinusitis, although the effect has not been consistent and antibiotic prescribing improvements reversed immediately after the study conclusion.…”

“…2 Several recent studies have demonstrated a significant decline in ambulatory antibiotic prescription in children. 2,3 Although few factors have been speculated to explain this pattern, little is known about the impact of influenza vaccination coverage on antibiotic prescription rates in children. 4 The purpose of this population-based retrospective cohort study is to examine the temporal association between influenza vaccination coverage and ambulatory antibiotic prescription rates in children in South Carolina.…”