5 Facts About Outpatient Antibiotic Prescribing in the U.S.

Insights about prescription landscape can help ensure appropriate use and slow development of resistance

5 Facts About Outpatient Antibiotic Prescribing in the U.S.
Pediatrics
Prescribing the right type of antibiotic is critical to minimize the risk of adverse side effects and slow the emergence of antibiotic resistance.
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A recent article in Pediatrics highlights research by The Pew Charitable Trusts on important progress being made in understanding outpatient antibiotic use in the United States. Although published in the journal of the American Academy of Pediatrics, the findings could help improve the use of antibiotics for both children and adults. Here are five of particular interest:

1 in 3 antibiotic prescriptions is unnecessary.

At least 30 percent of outpatient antibiotic prescriptions in the U.S. are unnecessary—this equals about 47 million prescriptions each year. Antibiotics should be prescribed only when they are likely to work. Using them when not medically needed accelerates development of resistance. Appropriate prescribing also protects patients from avoidable adverse effects of antibiotic use.

Southern states have some of the highest antibiotic prescribing rates.

Where you live may affect how likely you are to get an antibiotic prescription. Analyses by the Centers for Disease Control and Prevention (CDC) show higher rates of antibiotic prescribing in southern states and lower rates in western ones in 2015. Similar patterns were found in 2011-2014 data. Although the data cannot indicate if these higher rates are linked to unnecessary or inappropriate prescribing, they highlight regions where targeted antibiotic stewardship efforts may prove particularly useful.

For some common conditions, only half of patients receive the recommended first-line antibiotic.

Prescribing the right type of antibiotic is critical to minimize the risk of adverse side effects and slow the emergence of antibiotic resistance. The analysis found that children are more likely than adults with the same diagnosis to be prescribed first-line antibiotics—those recommended by medical guidelines.

Physicians are more likely to prescribe antibiotics when they believe the patient expects it.

Regardless of the diagnosis, some patients expect an antibiotic prescription from their physician. In other cases, patients may not have such expectations, but physicians often still believe they do. This patient pressure—real or perceived—increases the likelihood that physicians will prescribe an antibiotic.

Nurse practitioners and physician assistants play an important role in antibiotic stewardship

23 percent of all outpatient antibiotic prescriptions were written by nurse practitioners and physician assistants in 2015, up nearly two-thirds since 2011. A plurality (41%) is still written by primary care physicians.

To protect patients and slow the development of resistant bacteria, the U.S. national action plan for combating antibiotic-resistant bacteria set a national target to reduce unnecessary outpatient antibiotic prescriptions by 50 percent by 2020. To get there, patients, health care providers, health plans, health care quality organizations, medical professional societies, and state, local, and federal health agencies all must do their part.

David Hyun, M.D., is a senior officer, Rachel Zetts, M.P.H., is a principal associate, and Andrea Stoesz, M.P.H., is an associate with The Pew Charitable Trusts’ antibiotic resistance project.

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Patient
Report

Antibiotic Use in Outpatient Settings

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Report

Antibiotic use in outpatient health care settings, such as primary care offices and emergency rooms, represents the majority of dollars spent on antibiotics for human health care in the United States. Beginning in 2015, The Pew Charitable Trusts convened a panel of experts, including representatives from the Centers for Disease Control and Prevention (CDC) and other public health and medical experts to analyze current outpatient antibiotic prescribing habits in the United States, determine targets for reducing inappropriate prescribing, and identify steps needed to reach these targets.

Outpatient antibiotics selection
Outpatient antibiotics selection
Issue Brief

National Targets to Improve Outpatient Antibiotic Selection

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Issue Brief

Ensuring the appropriate use of antibiotics is critical to improving patient care and minimizing the development of antibiotic resistance. Antibiotic use in outpatient health care settings, such as primary care clinics and emergency rooms, represents the majority of dollars spent on antibiotics for human health in the United States and should be a focus for efforts to ensure that antibiotics are prescribed only when necessary and that the appropriate antibiotic is selected.

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Fact Sheet

Variation in Outpatient Antibiotic Prescribing in the United States

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Fact Sheet

Variation in Outpatient Antibiotic Prescribing in the United States

The prescribing of antibiotics in outpatient health care facilities, such as primary care clinics and emergency rooms, represents a large proportion of antibiotic use in the United States. One study found that these settings accounted for over 60 percent of all dollars spent on antibiotics in the U.S. in 2009. Because of this contribution to overall antibiotic prescribing, any efforts to minimize the threat of antibiotic resistance and improve patient safety must focus on improving antibiotic use in outpatient facilities.