Antibiotic Prescriptions in Children Fell From 2011-2016 but Increased Slightly in Adults

A new study has found that rates of outpatient oral antibiotic prescriptions in the United States fell by only 5% from 2011 to 2016, showing that the country may not be on track to meet targets for reducing inappropriate outpatient antibiotic use.

Antibiotic stewardship efforts within the health care community have become integral to stemming the problem of antibiotic overuse and antibiotic-resistant bacteria. According to the US Centers for Disease Control and Prevention (CDC), about 30% of antibiotics prescribed in the US are unnecessary, resulting in an excess of 47 million antibiotic prescriptions and fueling antibiotic resistance. The CDC’s National Action Plan for Combating Antibiotic-Resistant Bacteria set goals of reducing unnecessary antibiotic prescriptions by 50% by 2020, and reducing overall antibiotic prescriptions by 15%. A new study published in the journal Clinical Infectious Diseases suggests that the US is falling short of those goals.

“Recent estimates of large-scale, US antibiotic prescription trends are limited to convenience samples, making it difficult to evaluate progress in improving antibiotic prescribing nationally and to identify stewardship targets,” the investigators write. The objective of the new study, led by investigators from the CDC’s Office of Antibiotic Stewardship, was to describe trends in outpatient oral antibiotic prescriptions from 2011 to 2016 by year, region, patient age group and sex, antibiotic category, provider specialty, and state. It also aimed to describe trends in the ratio of broad- and narrow-spectrum outpatient oral antibiotic prescriptions overall and among adults and children.

Investigators used national prescription dispensing count data from IQVIA Xponent, which uses a proprietary projection based on outpatient prescriptions and pharmacy wholesale delivery information. Overall, they found that the number of oral antibiotic prescriptions dispensed from US community pharmacies declined from 273.3 million in 2011 to 270.2 million in 2016, a drop in the rate, from 877 prescriptions per 1000 persons a rate of 836 per 1000 persons and an overall decline of 5%. In their findings though, the study investigators note that antibiotic prescription rates were lowest in 2014 and remained relatively steady through 2016.

“This trend was entirely driven by prescriptions dispensed to children, with a 13% decrease in pediatric antibiotic prescriptions,” the research team found, noting that the rate of antibiotic prescribing in adults aged 20 years and older actually increased by 2%. In addition, although the highest proportion of antibiotic prescriptions were in adults aged 40 to 65 years, children under 2 years and adults aged 65 and older saw the highest antibiotic prescribing rates. When investigators studied the data by region, they found that the West saw a 10% decrease in overall antibiotic prescribing, the largest in the country.

During the study period there was also a decrease in the rate of broad-spectrum antibiotic prescriptions, especially macrolides and fluoroquinolones, and in the ratio of broad- to narrow-spectrum antibiotic prescriptions. “Due to the risk of adverse events, decreasing the use of unnecessarily broad-spectrum antibiotics is important for patient safety,” write the investigators. “A 2017 study found that broad-spectrum antibiotics were associated with a higher risk of adverse events than narrow-spectrum antibiotics in children with acute respiratory tract infections.”

In continued antibiotic stewardship efforts, the investigators note the importance of working with nurse practitioners and physician assistants, who they found had an increase in the proportion of antibiotics prescribed. They also noted that the study was limited by a lack of patient diagnosis data or number of visits, and therefore they were unable to evaluate if unnecessary antibiotic prescriptions declined.