Correspondence
U.S. Outpatient Antibiotic Prescribing, 2010
N Engl J Med 2013; 368:1461-1462April 11, 2013DOI: 10.1056/NEJMc1212055
- Article
To the Editor:
Antibiotic use is an important factor in the spread of antibiotic resistance. It is estimated that 50% of antibiotic prescriptions may be unnecessary.1,2 We analyzed data on the prescription of antibiotics to outpatients in the United States to identify the areas in which interventions addressing appropriate use could have the greatest effect.
Data on oral antibiotic prescriptions dispensed during 2010 in the United States were extracted from the IMS Health Xponent database, which represents a 100% projection of prescription activity on the basis of a sample of more than 70% of U.S. prescriptions. Antibiotics were categorized according to the IMS Health Uniform System of Classification. The numbers of prescriptions and census denominators were used to calculate prescribing rates. Prescriptions were totaled for 17 provider specialty groups on the basis of the self-designated specialty of the prescriber (as defined by the American Medical Association) associated with each prescription. The Xponent database provided the number of prescribers in each specialty for the calculation of the number of prescriptions per provider.
Health care providers prescribed 258.0 million courses of antibiotics in 2010, or 833 prescriptions per 1000 persons (Figure 1Figure 1
Antibiotic Prescriptions per 1000 Persons of All Ages According to State, 2010.; and Table S1 in the Supplementary Appendix, available with the full text of this letter at NEJM.org). Penicillins and macrolides were the most common categories prescribed. The most frequently prescribed antibiotic agent was azithromycin. Prescribing rates were higher among persons younger than 10 years of age and persons 65 years of age or older. Rates were also higher in the South (936 prescriptions per 1000 persons, as compared with the 639 prescriptions per 1000 persons in the West). Prescribing rates varied considerably according to provider specialty.Our analyses were subject to limitations. We were unable to directly assess the appropriateness of prescribing because our data did not capture patient visits and diagnoses. We were also unable to determine how many unique patients received a prescription. Finally, prescribing data may not accurately represent actual antibiotic consumption, since patient adherence to treatment regimens varies.
2 ReferencesLauri A. Hicks, D.O.
Thomas H. Taylor, Jr., M.S.
Centers for Disease Control and Prevention, Atlanta, GA
lhicks@cdc.gov Robert J. Hunkler
IMS Health, Plymouth Meeting, PAThe views expressed in this letter are those of the authors and do not necessarily represent the views of the CDC or of IMS Health or any of its affiliated or subsidiary entities.
Supported by the CDC, with the data set and consultation provided by IMS Health.
Disclosure forms provided by the authors are available with the full text of this letter at NEJM.org.
1
Office-related antibiotic prescribing for persons aged ≤14 years -- United States, 1993-1994 to 2007-2008. MMWR Morb Mortal Wkly Rep 2011;60:1153-1156
Medline2
Pichichero ME
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