Data on Outpatient Prescribing in the United States: What Do We Know?

Lauri A. Hicks, DO, captain, US Public Health Service, director, Office of Antibiotic Stewardship, medical director, Get Smart: Know When Antibiotics Work, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, discusses antibiotic prescribing data, with an emphasis on outpatient settings.

Interview Transcript (slightly modified for readability)

“We have really good data that give us a pretty nice national view of how antibiotics are prescribed in outpatient settings. We know that about 835 prescriptions per 1000 people are prescribed each year in the United States, just in outpatient settings. That really is enough antibiotic prescribing for every 5 out of 6 people to receive an antibiotic each year; it’s about 266 million antibiotic prescriptions just in that setting.

When we think about hospitals, we know that about 50% of patients who are hospitalized will receive at least one antibiotic during their course of stay; so, not only are we seeing a lot of antibiotic use in the outpatient setting, [such as] in doctors’ offices [and] emergency rooms, we’re also seeing a lot of antibiotic prescribing in hospitals.

We recently published a study where we looked at the number of prescriptions and the proportion of prescriptions that were unnecessary in doctors’ offices and emergency rooms, and we found that at least 30% of all antibiotics prescribed in these settings are completely unnecessary, which is a pretty alarming number. That actually equated to, in that particular study, 47 million prescriptions per year. We know that in addition to unnecessary prescribing, that there is [an] issue related to appropriate selection of antibiotics and making sure that the patient also gets the right duration and right dose of antibiotic.

Another recent study that we published related to outpatient antibiotic prescribing showed that about 52% of patients get the first-line agent for three common respiratory infections: ear infections, sinusitis, [and] pharyngitis; we think that number should be closer to at least 80%. We know that there’s a lot of opportunity to improve how we’re using antibiotics in that setting. In hospitals we know that there’s a lot of opportunity to improve how we’re selecting antibiotics; when patients get started on antibiotics they’re often treated empirically before we know what’s causing the infection or before we know whether or not the patient has the infection, and so, there’s often the opportunity to stop the antibiotics within 48-72 hours or to change to a better antibiotic.

In terms of what the implications are if a patient receives an antibiotic when [one is] not necessary, it’s really important to know that there [is] a potential for adverse events associated with antibiotics; [these] range from minor side effects, like rash and sometimes diarrhea, but they can actually be much more severe, [like] anaphylaxis. What we talk about a lot now is the problem of Clostridium difficile, which is a potentially deadly diarrhea, and the biggest risk factor for that infection is being exposed to an antibiotic.”