Inappropriate Antibiotic Prescribing Remains Widespread in US

Inappropriate outpatient antibiotic prescribing remains a widespread issue in the United States, despite the existence of guidelines intended to reduce these patterns, according to findings from a recent study.

Researchers reached this conclusion following an assessment of national administrative claims data from PARTICIPANTS, a pharmacy benefits manager. Their study covered 3 years of data from Express Scripts Holding Company beneficiaries.
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Results indicated that approximately 39 million insurance beneficiaries filled 98 million outpatient antibiotic prescriptions throughout the 3-year period, indicating that no significant changes in individual or overall annual antibiotic prescribing rates had occurred.

Azithromycin, amoxicillin, amoxicillin/clavulanate, ciprofloxacin, and cephalexin were found to be the most commonly prescribed antibiotics.

The researchers observed significant variance in prescribing rates by season and found that antibiotics were 42% more likely to be prescribed during February vs September (peak-to-trough ratio [PTTR] 1.42). Similar prescribing trends were observed for azithromycin (PTTR 2.46), amoxicillin (PTTR 1.52), and amoxicillin/clavulanate (PTTR 1.78).

“This study demonstrates that annual national outpatient antibiotic prescribing practices remained unchanged during our study period,” the researchers wrote. “Furthermore, seasonal peaks in antibiotics generally used to treat viral upper respiratory tract infections remained unchanged during cold and influenza season.”

“These results suggest that inappropriate prescribing of antibiotics remains widespread, despite the concurrent release of several guideline-based best practices intended to reduce inappropriate antibiotic consumption; however, further research linking national outpatient antibiotic prescriptions to associated medical conditions is needed to confirm these findings,” they concluded.

—Christina Vogt

Reference:

Durkin MJ, Jafarzadeh SR, Hsueh K, et al. Outpatient antibiotic prescription trends in the United States: a national cohort study [Published online February 27, 2018]. Infect Control Hosp Epidemiol. https://doi.org/10.1017/ice.2018.26.