Author(s): Grijalva CG, Nuorti JP, Griffin MR
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Abstract CONTEXT: During the 1990s, antibiotic prescriptions for acute respiratory tract infection (ARTI) decreased in the United States. The sustainability of those changes is unknown. OBJECTIVE: To assess trends in antibiotic prescriptions for ARTI. DESIGN, SETTING, AND PARTICIPANTS: The National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data (1995-2006) were used to examine trends in antibiotic prescription rates by antibiotic indication and class. Annual survey data and census denominators were combined in 2-year intervals for rate calculations. MAIN OUTCOME MEASURES: National annual visit rates and antibiotic prescription rates for ARTI, including otitis media (OM) and non-ARTI. RESULTS: Among children younger than 5 years, annual ARTI visit rates decreased by 17\% (95\% confidence interval [CI], 9\%-24\%), from 1883 per 1000 population in 1995-1996 to 1560 per 1000 population in 2005-2006, primarily due to a 33\% (95\% CI, 22\%-43\%) decrease in OM visit rates (950 to 634 per 1000 population, respectively). This decrease was accompanied by a 36\% (95\% CI, 26\%-45\%) decrease in ARTI-associated antibiotic prescriptions (1216 to 779 per 1000 population). Among persons aged 5 years or older, ARTI visit rates remained stable but associated antibiotic prescription rates decreased by 18\% (95\% CI, 6\%-29\%), from 178 to 146 per 1000 population. Antibiotic prescription rates for non-OM ARTI for which antibiotics are rarely indicated decreased by 41\% (95\% CI, 22\%-55\%) and 24\% (95\% CI, 10\%-37\%) among persons younger than 5 years and 5 years or older, respectively. Overall, ARTI-associated prescription rates for penicillin, cephalosporin, and sulfonamide/tetracycline decreased. Prescription rates for azithromycin increased and it became the most commonly prescribed macrolide for ARTI and OM (10\% of OM visits). Among adults, quinolone prescriptions increased. CONCLUSIONS: Overall antibiotic prescription rates for ARTI decreased, associated with fewer OM visits in children younger than 5 years and with fewer prescriptions for ARTI for which antibiotics are rarely indicated. However, prescription rates for broad-spectrum antibiotics increased significantly.
This article was published in JAMA
and referenced in Health Economics & Outcome Research: Open Access