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Antibiotic prescribing increases among nurse practitioners, physician assistants
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SAN DIEGO — Researchers have observed an increase in antibiotic prescribing among nurse practitioners and physician assistants, particularly during the winter months. In addition, dentists now appear to be responsible for a large proportion of antibiotic prescribing in the United States.
“Nationally, antibiotic prescribing rates have decreased, but prescriptions for broad-spectrum agents have increased,” Katie Suda, PharmD, MS, of the University of Illinois at Chicago, said during a presentation. “It is unknown if national decreases observed in antibiotic prescribing differ by provider group.”
Katie Suda
Suda and colleagues conducted a retrospective, cross-sectional observational study of outpatient antibiotic prescribing by different provider types from 2005 to 2010. Data were collected from IMS Health Xponent, a nationally representative database of outpatient prescriptions dispensed in the U.S. The researchers calculated prescribing rates in terms of both prescription-based and population-based estimates.
According to Suda, there were over 1.56 billion antibiotic prescriptions dispensed in the outpatient setting in the U.S. from 2005 to 2010. The majority of these prescriptions were dispensed by physicians (80.4%), followed by dentists (10.4%), nurse practitioners (4.4%) and physician assistants (4.9%).
“We did see a significant decrease in prescriptions prescribed by physicians in 2010 as compared to 2005,” Suda said, and prescribing rates also decreased among dentists (P = .03).
However, antibiotic prescribing doubled among nurse practitioners and physician assistants (P < .01 for all), and the prescribing of broad-spectrum antibiotics, such as macrolides and quinolones, also increased among these mid-level providers (P < .01 for all).
Suda said there were significant decreases in provider- and population-based prescribing rates for physicians and dentists, but again, significant increases were observed for nurse practitioners and physician assistants.
Specifically, penicillins were the most frequently prescribed antibiotics across all providers, but their usage decreased among physicians and dentists (P < .01 for all). However, the prescribing of penicillins, cephalosporins, macrolides, sulfonamides and tetracyclines increased among mid-level providers, Suda said.
Results also suggested that antibiotic prescription rates were highest in the winter among all groups (P < .0001) with the exception of dentists. “Seasonality of antibiotic prescribing can be an indicator of inappropriate use because the majority of the increased antibiotic prescribing in the winter months is for viral respiratory tract infections,” she said.
Suda emphasized that interventions should focus on reversing the increasing prescribing trends among mid-level providers. In addition, antibiotic prescribing by dentists represents an area in need of further study, she said, given that one out of every 10 antibiotic prescriptions were dispensed by this provider group. – by John Schoen
Reference:
Suda K, et al. Antibiotic Prescriptions in the Community by Provider Group in the U.S., 2005-2010. Presented at: Interscience Conference on Antimicrobial Agents and Chemotherapy; Sept. 17-21, 2015; San Diego.
Disclosure: Suda reports no relevant financial disclosures. Another author reports being an employee of IMS Health.