1 in 4 US antibiotic prescriptions found unnecessary

  • Chua K-P et al
  • BMJ
  • 16 Jan 2019

  • curated by Liz Scherer
  • Clinical Essentials
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Takeaway

  • Roughly a quarter of outpatient prescriptions filled in the United States in 2016 were inappropriate; 28.5% were not associated with a recent diagnostic code.

Why this matters

  • Rates of inappropriate prescribing by US clinicians might be higher than previously believed, especially among adults.
  • Familiarity with CDC prescribing guidelines for children, adults warranted.

Key results

  • 19,203,264 enrollees (75.9% [14,571,944] adults, 24.1% [4,631,320] children, 51.7% [9,935,791] women).
  • Mean 2.0 antibiotic prescriptions/user filled; most commonly azithromycin (19.0% [2,931,242]), amoxicillin (18.2% [2,818,939]), amoxicillin-clavulanate (11.6% [1,784,921]).
  • Among 15,455,834 fills, 12.8% (1,973,873) were appropriate, 35.5% (5,487,003) potentially appropriate, 23.2% (3,592,183) inappropriate, 28.5% (4,402,775) not associated with recent diagnostic code.
    • 99.8% (4,392,068) of unassociated fills were not associated with any claims.
  • Most frequent diagnoses for inappropriate fills were acute bronchitis, acute upper respiratory tract infections, respiratory symptoms (cough).
  • Of 11,053,059 fills classified as appropriate, potentially appropriate, or inappropriate, 74.7% (8,257,536) were prescribed in office-based settings, 6.2% (222,804) urgent care, 4.7% (168,396) emergency departments.

Study design

  • Cross-sectional study evaluating appropriateness of outpatient antibiotic prescriptions among privately insured US children, nonelderly adults based on ICD-10 CM diagnostic codes.
  • Funding: Agency for Healthcare Research and Quality.

Limitations

  • Misclassification bias.
  • Out-of-pocket payments uncaptured.
  • Prescribing based solely on indications.
  • Nongeneralizable.