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    Outpatient Antibiotic Prescribing in the United States: 2000 to 2010

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    2014_06_Lee.pdf (375.4Kb)
    Date
    2014-06
    Author
    Lee, Grace C.
    Reveles, Kelly R.
    Attridge, Russell T.
    Lawson, Kenneth A.
    Mansi, Ishak A.
    Lewis, James S.
    Frei, Christopher R.
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    Abstract
    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.
    Department
    Pharmacy
    Subject
    antibiotic
    prescribing
    ambulatory care
    antibiotic resistance
    surveillance
    respiratory-tract infections
    pneumococcal conjugate vaccine
    antimicrobial resistance
    diseases society
    adults
    children
    trends
    bronchitis
    principles
    physicians
    medicine, general & internal
    URI
    http://hdl.handle.net/2152/43359
    Citation
    Lee, Grace C., Kelly R. Reveles, Russell T. Attridge, Kenneth A. Lawson, Ishak A. Mansi, James S. Lewis, and Christopher R. Frei. "Outpatient antibiotic prescribing in the United States: 2000 to 2010." BMC medicine, Vol. 12, No. 1 (Jun., 2014): 1.
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