25%-47% of antibiotic prescriptions in U.S. inappropriate, reflecting a global problem

  • Ray MJ et al
  • BMJ
  • 13.12.2019

  • von Liz Scherer
  • Clinical Essentials
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Takeaway

  • In 2015, 25% of antibiotic prescriptions in the U.S. lacked documented coding, highlighting a larger challenge to antibiotic stewardship efforts globally.

  • See related editorial

Why this matters

  • ~23%-36% of antibiotics are prescribed inappropriately in the UK and lack coded diagnoses.

  • Consider coding all infections (not just those requiring antibiotics) to provide a baseline for comparing prescribing against European quality indicators.

Key results

  • 990.8 million ambulatory care visits; 13.2% (130.5 million; 95% CI, 11.6%-13.7%) linked to antibiotic prescriptions.

  • 57% (95% CI, 52%-62%), 25% (95% CI, 21%-29%) were appropriate, inappropriate, respectively.

  • 18% (95% CI, 15%-22%) lacked indication.

  • Overall, this corresponds to 23.7 million antibiotic prescriptions without a documented indication. 

  • Adult men (≥18 years) likelier to receive an undocumented prescription (aOR, 2.3 [95% CI, 1.0-5.3]).

  • Other associated factors: specialists aOR, 2.1 (95% CI, 1.2-3.7); longer visit ≥17 minutes aOR, 1.6 (95% CI, 1.1-2.5).

  • Sulfonamides (aOR, 4.9 [95% CI, 1.5-15.7]), urinary anti-infectives (aOR, 3.1 [95% CI, 1.3-7.6]) most commonly prescribed without documentation. 

Study design

  • Cross-sectional evaluation of frequency of, patient/provider/visit level characteristics associated with antibiotic prescribing in the absence of a documented indication based on National Ambulatory Medical Care Survey data.

  • Funding: None.

Limitations

  • Cross-sectional.
  • Nongeneralizable.
  • Limited ICD-9 code inclusion.
  • Only in-person encounters captured.