Open Access Highly Accessed Research article

Outpatient antibiotic prescribing in the United States: 2000 to 2010

Grace C Lee12, Kelly R Reveles12, Russell T Attridge23, Kenneth A Lawson1, Ishak A Mansi4, James S Lewis12 and Christopher R Frei12*

Author Affiliations

1 College of Pharmacy, The University of Texas at Austin, Austin, TX, USA

2 School of Medicine, The University of Texas Health Science Center at San Antonio, Pharmacotherapy Education and Research Center, San Antonio, TX, USA

3 Feik School of Pharmacy, University of the Incarnate Word, San Antonio, TX, USA

4 Department of General Internal Medicine, Veterans Affairs North Texas Health Care System and University of Texas Southwestern Medical Center, Dallas, TX, USA

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BMC Medicine 2014, 12:96  doi:10.1186/1741-7015-12-96

Published: 11 June 2014

Abstract

Background

The 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.

Methods

We 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).

Results

An 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.

Conclusions

Antibiotic 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.

Keywords:
Antibiotic; Prescribing; Ambulatory care; Antibiotic resistance; Surveillance