Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011
Open accessAbstract
IMPORTANCE: The National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal of reducing inappropriate outpatient antibiotic use by 50% by 2020, but the extent of inappropriate outpatient antibiotic use is unknown. OBJECTIVE: To estimate the rates of outpatient oral antibiotic prescribing by age and diagnosis, and the estimated portions of antibiotic use that may be inappropriate in adults and children in the United States. DESIGN, SETTING, AND PARTICIPANTS: Using the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, annual numbers and population-adjusted rates with 95% confidence intervals of ambulatory visits with oral antibiotic prescriptions by age, region, and diagnosis in the United States were estimated. EXPOSURES: Ambulatory care visits. MAIN OUTCOMES AND MEASURES: Based on national guidelines and regional variation in prescribing, diagnosis-specific prevalence and rates of total and appropriate antibiotic prescriptions were determined. These rates were combined to calculate an estimate of the appropriate annual rate of antibiotic prescriptions per 1000 population. RESULTS: Of the 184,032 sampled visits, 12.6% of visits (95% CI, 12.0%-13.3%) resulted in antibiotic prescriptions. Sinusitis was the single diagnosis associated with the most antibiotic prescriptions per 1000 population (56 antibiotic prescriptions [95% CI, 48-64]), followed by suppurative otitis media (47 antibiotic prescriptions [95% CI, 41-54]), and pharyngitis (43 antibiotic prescriptions [95% CI, 38-49]). Collectively, acute respiratory conditions per 1000 population led to 221 antibiotic prescriptions (95% CI, 198-245) annually, but only 111 antibiotic prescriptions were estimated to be appropriate for these conditions. Per 1000 population, among all conditions and ages combined in 2010-2011, an estimated 506 antibiotic prescriptions (95% CI, 458-554) were written annually, and, of these, 353 antibiotic prescriptions were estimated to be appropriate antibiotic prescriptions. CONCLUSIONS AND RELEVANCE: In the United States in 2010-2011, there was an estimated annual antibiotic prescription rate per 1000 population of 506, but only an estimated 353 antibiotic prescriptions were likely appropriate, supporting the need for establishing a goal for outpatient antibiotic stewardship.
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Approximately 30% of antibiotic prescriptions are unnecessary, equating to 47 million prescriptions per year.
“The Center for Disease Control found that approximately 30 % of antibiotic prescriptions are unnecessary, equating to 47 million prescriptions per year (Fleming-Dutra et al., 2016).”
From Review of emerging contaminants in green stormwater infrastructure: antibiotic resistance genes, microplastics, tire wear particles, PFAS, and temperature (2024) · cites this paper as Fleming-Dutra et al., 2016
The Discussion estimates that 30% of 154 million annual outpatient oral antibiotic prescriptions in the United States may have been inappropriate—approximately 46–47 million. The citing sentence omits the outpatient setting and presents a qualified estimate as a definite finding about antibiotic prescriptions generally. Our copy provides no page number for the Discussion passage. (LLM, conf=0.88)
Experimental — accuracy not yet measuredGreater population-wide antibiotic exposure could help drive high rates of bacterial infection.
“Increases in population-wide exposure to antibiotics 177 might contribute to high rates of bacterial infection.178”
From Influence of the Gut Microbiome, Diet, and Environment on Risk of Colorectal Cancer (2020) · cites this paper as [177]
Antibiotics are regularly prescribed for viral respiratory conditions.
“This is primarily because antibiotics are regularly prescribed for respiratory conditions, such as the common cold, bronchitis, and sinus and ear infections, that are caused by viruses, which are not affected by antibiotics (Fleming-Dutra et al., 2016).”
From Review of emerging contaminants in green stormwater infrastructure: antibiotic resistance genes, microplastics, tire wear particles, PFAS, and temperature (2024) · cites this paper as Fleming-Dutra et al., 2016
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- Authors
- Fleming-Dutra, K. E., Hersh, A. L., Shapiro, D. J., Bartoces, M., Enns, E. A., File, T. M., Finkelstein, J. A., Gerber, J. S., Hyun, D. Y., Linder, J. A., Lynfield, R., Margolis, D. J., May, L. S., Merenstein, D., Metlay, J. P., Newland, J. G., Piccirillo, J. F., Roberts, R. M., Sanchez, G. V., Suda, K. J., Thomas, A., Woo, T. M., Zetts, R. M., & Hicks, L. A.
- Affiliations
- Centers for Disease Control and Prevention (US)
- University of Utah (US)
- University of California, San Francisco (US)
- University of Minnesota (US)
- Summa Health System (US)
- Boston Children's Hospital (US)
- Children's Hospital of Philadelphia (US)
- Pew Charitable Trusts (US)
- Brigham and Women's Hospital (US)
- Minnesota Department of Health (US)
- University of Pennsylvania (US)
- University of California, Davis (US)
- Georgetown University Medical Center (US)
- Massachusetts General Hospital (US)
- Washington University in St. Louis (US)
- University of Illinois Chicago (US)
- Oregon Public Health Division, Portland
- Pacific Lutheran University (US)
- Corresponding author
- Fleming-Dutra, Katherine E.
- ORCID
- Fleming-Dutra, Katherine E.
- Hersh, Adam L.
- Shapiro, Daniel J.
- Enns, Eva A.
- File, Thomas M.
- Finkelstein, Jonathan A.
- Gerber, Jeffrey S.
- Hyun, David Y.
- Linder, Jeffrey A.
- Lynfield, Ruth
- Margolis, David J.
- Merenstein, Daniel
- Metlay, Joshua P.
- Newland, Jason G.
- Piccirillo, Jay F.
- Roberts, Rebecca M.
- Sanchez, Guillermo V.
- Suda, Katie J.
- Thomas, Ann
- Woo, Teri Moser
- Zetts, Rachel M.
- Hicks, Lauri A.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2016-05-03
- Volume
- 315
- Issue
- 17
- Pages
- 1864
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W2347049117
- Cited by
- 1,740
- References
- 38
- Citations by year
- 2026: 109 · 2025: 133 · 2024: 168 · 2023: 152 · 2022: 197 · 2021: 230 · 2020: 244 · 2019: 200 · 2018: 158 · 2017: 109 · 2016: 34 · 2014: 1
- FWCI
- 116.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- inappropriate antibiotic prescribing, outpatient antibiotic use, antibiotic resistance, antibiotic stewardship, acute respiratory infections, sinusitis, suppurative otitis media, pharyngitis, appropriateness of antibiotic prescribing, outpatient visits, prescribing guidelines, children and adults, regional variation in prescribing, United States
- MeSH terms
- Adolescent, Adult, Aged, Ambulatory Care, Anti-Bacterial Agents, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Male, Middle Aged, Otitis Media, Suppurative, Pharyngitis, Practice Patterns, Physicians', Respiratory Tract Infections, United States, Prevalence, Health Care Surveys, Inappropriate Prescribing
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