This article is more than 5 years old. Information may no longer be current.
Efforts needed to continue judicious use of antibiotics
Click Here to Manage Email Alerts
CHICAGO — Antibiotic prescribing has increased among all US adults. However, trends varied by diagnosis and use of specific antibiotic classes varied by age, according to data presented at the 2011 Interscience Conference on Antimicrobial Agents and Chemotherapy.
Previous research indicate that older adults may be more likely to receive aggressive antibiotics because of age-associated decline in immune status and multiple comorbidities, according to background data in the study abstract.
For this reason, Jessina McGregor, PhD, assistant professor at Oregon State University, and colleagues set out to assess antibacterial prescribing trends among adults aged 65 years and older in comparison with younger adults aged 18 to 64 years.
Data were pooled from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey between 2002 and 2008 on visits to emergency and outpatient departments. ICD-9 codes were used to identify visits for any infectious disease, including skin and soft tissue infections (SSTIs), urinary tract infections (UTIs) and acute respiratory tract infections (ARTIs).
Of 798,408,046 average visits per year, 17% of young adults and 10% of older adults were diagnosed with an infection (P<.01). During the study period, the overall proportion of visits in which an antibiotic was prescribed increased among young adults from 12% to 18% (P<.01) and among older adults from 8% to 16% (P<.01).
Specifically, prescriptions for SSTIs increased from 65% to 79% among young adults (P<.01) and from 59% to 73% among older adults (P=.42); prescriptions for UTIs increased from 76% to 83% among young adults (P=.05) and from 46% to 71% among older adults (P=.13); and prescriptions for ARTIs increased from 47% to 58% in older adults (P=.59), but remained steady for young adults (64%; P=.59).
Older adults were significantly more likely to receive quinolones (P<.01); young adults were more likely to receive macrolides (P<.01).
For more information:
- McGregor J. # K-1884. Presented at: the 2011 ICAAC; Sept. 17-20; Chicago.
Disclosure: The researchers report no relevant financial disclosures.
McGregor and others utilized National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey results to compare antibacterial prescribing trends between older (> 65 years of age) and younger (age 18-64) adults. Data represented > 1 million infectious disease diagnoses of more than 7 million visits from 2002-2009. Overall, 16% of younger adults and 9% of older adults had a visit of an infectious disease. The proportion of visits with an antibacterial prescription did not change significantly over this survey period (around 47% in younger adults and 41 to 43% in older adults). Older adults were more likely to receive a quinolone while younger adults were more likely to receive a macrolide.
One concern with this study is that infections were identified using ICD-9 codes, which are not specific enough to differentiate viral from bacterial etiology (eg, sinusitis, pharyngitis, bronchitis), so does not allow specific assessment whether or not antibacterials were actually warranted (assuming a correct diagnosis of bacterial infection could be established, which as we know is not precise on a clinical basis). However, I believe we can safely assume many, if not the majority, of such infections were not bacterial in etiology. Several prior observational studies have demonstrated inappropriate use of antibacterials for likely viral infections. Appropriate use initiatives by CDC and various professional societies and organizations have focused on strategies to reduce unnecessary use. Thus, the observation in this study of no reduction of antibacterial prescribing is disappointing to me. The authors suggest that more detailed individual-level data are needed to further explore differences in antibiotic prescribing. To me, the take home message of this study is that until we have such additional data, we need to increase our emphasis on more appropriate use education for clinicians and patients. This is particularly important if we are to maintain utility of our present antimicrobial agents in the era of a limited pipeline for new agents in the near future.
–Thomas M. File Jr., MD
Infectious Disease News Editorial Board member
Disclosure: Dr. File reports no relevant financial disclosures.
 |
Follow InfectiousDiseaseNews.com on Twitter. |