Unnecessary antibiotic prescribing decreases in ambulatory care settings over 5-year period
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The prescribing of unnecessary antibiotics in U.S. physician offices and EDs decreased slightly, from 30% to 28%, between 2010 and 2015, according to findings published in Clinical Infectious Diseases.
“Despite growing attention to the need for outpatient stewardship, the overuse of antibiotics in outpatient settings is common,” Adam L. Hersh, MD, PhD, professor of pediatrics in the pediatric infectious diseases division at University of Utah, told Healio. “Several years ago, we conducted a study that showed at least 30% of antibiotics prescribed in outpatient settings were unnecessary. Our goal was to see if changes have occurred.”
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Hersh and colleagues identified visits and antibiotic prescriptions using National Ambulatory Medical Care and National Hospital Ambulatory Medical Care surveys, as well as nationally representative samples of visits to non-federally employed, office-based physicians and hospital-based EDs. The researchers grouped data into 2-year periods (2010-11, 2012-13 and 2014-15) and used the tiered diagnosis system from a previous CDC study to assign a single diagnosis to each visit according to the most likely reason for antibiotics. They classified diagnoses as acute respiratory infection (ARI) and other conditions. ARIs considered inappropriate for antibiotics included asthma, allergy, bronchitis, bronchiolitis, influenza, nonsuppurative otitis media, viral URI and viral pneumonia.
“We found that minimal changes have occurred overall from 2010 to 2015 in the percentage of antibiotics prescribed that were unnecessary. The percentage declined from 30% at the beginning of the study period to 28% at the end,” Hersh said, while also noting a substantial decline in unnecessary antibiotic prescribing in children.
The estimated number of visits to physician offices and EDs per 1,000 population, regardless of antibiotic prescriptions, was 3,548 from 2010 to 2011, 3,342 from 2012 to 2013 and 3,356 from 2014 to 2015. The number of visits for ARIs per 1,000 population decreased from 411 in 2010 to 2011to 307 in 2014-15, representing a 25% decrease (rate ratio [RR] = 0.75; 95% CI, 0.71-0.79).
The researchers observed an 8% decrease (RR = 0.92; 95% CI, 0.87-0.98) in the overall number of antibiotic prescriptions per 1,000 population from 2010 to 2011 to 2014 to 2015 and a 26% decline (RR = 0.74; 95% CI, 0.72-0.76) for ARIs. Declines in antibiotic prescriptions per 1,000 population for ARIs happened in all age groups but were greatest among patients aged 19 years and younger, with a 32% decline (RR = 0.68; 95% CI, 0.67-0.7) from 2010-11 to 2014-15.
The percentage of unnecessary antibiotic prescriptions decreased from 30% in 2010-11 to 28% in 2014-15. Unnecessary antibiotic prescriptions also decreased overall among children aged 19 years and younger, from 32% of antibiotic prescriptions between 2010 and 2011 to 19% between 2014 and 2015, but did not change among adult age groups.
“Continued efforts to determine the most effective strategies for outpatient stewardship are needed,” Hersh said.
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