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Antimicrobial drug prescription in ambulatory care settings, United States, 1992-2000.

McCaig LF, Besser RE, Hughes JM - Emerging Infect. Dis. (2003)

Bottom Line: In that period, the population- and visit-based antimicrobial prescribing rates in ambulatory care settings decreased by 23% and 25%, respectively, driven largely by a decrease in prescribing by office-based physicians.Antimicrobial prescribing rates changed as follows: amoxicillin and ampicillin, -43%; cephalosporins, -28%; erythromycin, -76%; azithromycin and clarithromycin, +388%; quinolones, +78%; and amoxicillin/clavulanate, +69%.This increasing use of azithromycin, clarithromycin, and quinolones warrants concern as macrolide- and fluoroquinolone-resistant pneumococci are increasing.

View Article: PubMed Central - PubMed

Affiliation: National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA. lfm1@cdc.gov

ABSTRACT
During the 1990s, as antimicrobial resistance increased among pneumococci, many organizations promoted appropriate antimicrobial use to combat resistance. We analyzed data from the National Ambulatory Medical Care Survey, an annual sample survey of visits to office-based physicians, and the National Hospital Ambulatory Medical Care Survey, an annual sample survey of visits to hospital emergency and outpatient departments, to describe trends in antimicrobial prescribing from 1992 to 2000 in the United States. Approximately 1,100-1,900 physicians reported data from 21,000-37,000 visits; 200-300 outpatient departments reported data for 28,000-35,000 visits; approximately 400 emergency departments reported data for 21,000-36,000 visits each year. In that period, the population- and visit-based antimicrobial prescribing rates in ambulatory care settings decreased by 23% and 25%, respectively, driven largely by a decrease in prescribing by office-based physicians. Antimicrobial prescribing rates changed as follows: amoxicillin and ampicillin, -43%; cephalosporins, -28%; erythromycin, -76%; azithromycin and clarithromycin, +388%; quinolones, +78%; and amoxicillin/clavulanate, +69%. This increasing use of azithromycin, clarithromycin, and quinolones warrants concern as macrolide- and fluoroquinolone-resistant pneumococci are increasing.

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Trends in annual antimicrobial prescribing rates for persons >15 years of age by setting—United States, 1992–2000. Note: trend for office setting, p<0.001; trend for outpatient departments, p=0.002.
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Figure 4: Trends in annual antimicrobial prescribing rates for persons >15 years of age by setting—United States, 1992–2000. Note: trend for office setting, p<0.001; trend for outpatient departments, p=0.002.

Mentions: From 1992 through 2000, the number of antimicrobial drug prescriptions in ambulatory care settings in the United States declined from 151 million (95% CI 132 to 169) to 126 million (95% CI 112 to 141), while the number of visits rose from 908 million (95% CI 842 to 975) to 1.0 billion (95% CI 0.9 to 1.1). The annual population-based rate of antimicrobial drug use decreased by 23% (from 599 [95% CI 524 to 673] antimicrobial drug prescriptions per 1,000 persons to 461[95% CI 409 to 513]) (p<0.001), and the annual visit-based rate of antimicrobial drug use declined by 25% (from 166 [95% CI 152 to 179] antimicrobial drug prescriptions per 1,000 visits to 125 [95% CI 116 to 133]) (p<0.001) during the study period (Figure 1). All subsequent rates shown are visit-based rates. The antimicrobial prescribing rate at ambulatory care visits decreased in persons <15 years of age (–32%; p<0.001), 15–24 years (–9%; p=0.007), and 25–44 years of age (–17%; p<0.001). No trend was found among persons >45 years (p=0.03) (Figure 2). For children <15 years of age, antimicrobial prescribing rates decreased by 34% in physicians’ offices (p<0.001) and by 13% in emergency departments (p<0.001), but no trend was observed in the prescribing rates in outpatient departments (p=0.17) (Figure 3). The physician’s office was the only ambulatory care setting which experienced a decline in antimicrobial prescribing rates for persons >15 years (–24%; p<0.001), while an increasing trend was seen in outpatient departments (+35%; [is a p missing?]=0.002), and no change was observed in emergency departments (Figure 4). For visits to physician offices, antimicrobial prescribing rates decreased for general and orthopedic surgeons (–45%; p<0.001), general and family practitioners (–34%; p<0.001), pediatricians (–33%; p<0.001), and dermatologists (–4%; p=0.006) (Table 1).


Antimicrobial drug prescription in ambulatory care settings, United States, 1992-2000.

McCaig LF, Besser RE, Hughes JM - Emerging Infect. Dis. (2003)

Trends in annual antimicrobial prescribing rates for persons >15 years of age by setting—United States, 1992–2000. Note: trend for office setting, p<0.001; trend for outpatient departments, p=0.002.
© Copyright Policy
Related In: Results  -  Collection

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Figure 4: Trends in annual antimicrobial prescribing rates for persons >15 years of age by setting—United States, 1992–2000. Note: trend for office setting, p<0.001; trend for outpatient departments, p=0.002.
Mentions: From 1992 through 2000, the number of antimicrobial drug prescriptions in ambulatory care settings in the United States declined from 151 million (95% CI 132 to 169) to 126 million (95% CI 112 to 141), while the number of visits rose from 908 million (95% CI 842 to 975) to 1.0 billion (95% CI 0.9 to 1.1). The annual population-based rate of antimicrobial drug use decreased by 23% (from 599 [95% CI 524 to 673] antimicrobial drug prescriptions per 1,000 persons to 461[95% CI 409 to 513]) (p<0.001), and the annual visit-based rate of antimicrobial drug use declined by 25% (from 166 [95% CI 152 to 179] antimicrobial drug prescriptions per 1,000 visits to 125 [95% CI 116 to 133]) (p<0.001) during the study period (Figure 1). All subsequent rates shown are visit-based rates. The antimicrobial prescribing rate at ambulatory care visits decreased in persons <15 years of age (–32%; p<0.001), 15–24 years (–9%; p=0.007), and 25–44 years of age (–17%; p<0.001). No trend was found among persons >45 years (p=0.03) (Figure 2). For children <15 years of age, antimicrobial prescribing rates decreased by 34% in physicians’ offices (p<0.001) and by 13% in emergency departments (p<0.001), but no trend was observed in the prescribing rates in outpatient departments (p=0.17) (Figure 3). The physician’s office was the only ambulatory care setting which experienced a decline in antimicrobial prescribing rates for persons >15 years (–24%; p<0.001), while an increasing trend was seen in outpatient departments (+35%; [is a p missing?]=0.002), and no change was observed in emergency departments (Figure 4). For visits to physician offices, antimicrobial prescribing rates decreased for general and orthopedic surgeons (–45%; p<0.001), general and family practitioners (–34%; p<0.001), pediatricians (–33%; p<0.001), and dermatologists (–4%; p=0.006) (Table 1).

Bottom Line: In that period, the population- and visit-based antimicrobial prescribing rates in ambulatory care settings decreased by 23% and 25%, respectively, driven largely by a decrease in prescribing by office-based physicians.Antimicrobial prescribing rates changed as follows: amoxicillin and ampicillin, -43%; cephalosporins, -28%; erythromycin, -76%; azithromycin and clarithromycin, +388%; quinolones, +78%; and amoxicillin/clavulanate, +69%.This increasing use of azithromycin, clarithromycin, and quinolones warrants concern as macrolide- and fluoroquinolone-resistant pneumococci are increasing.

View Article: PubMed Central - PubMed

Affiliation: National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA. lfm1@cdc.gov

ABSTRACT
During the 1990s, as antimicrobial resistance increased among pneumococci, many organizations promoted appropriate antimicrobial use to combat resistance. We analyzed data from the National Ambulatory Medical Care Survey, an annual sample survey of visits to office-based physicians, and the National Hospital Ambulatory Medical Care Survey, an annual sample survey of visits to hospital emergency and outpatient departments, to describe trends in antimicrobial prescribing from 1992 to 2000 in the United States. Approximately 1,100-1,900 physicians reported data from 21,000-37,000 visits; 200-300 outpatient departments reported data for 28,000-35,000 visits; approximately 400 emergency departments reported data for 21,000-36,000 visits each year. In that period, the population- and visit-based antimicrobial prescribing rates in ambulatory care settings decreased by 23% and 25%, respectively, driven largely by a decrease in prescribing by office-based physicians. Antimicrobial prescribing rates changed as follows: amoxicillin and ampicillin, -43%; cephalosporins, -28%; erythromycin, -76%; azithromycin and clarithromycin, +388%; quinolones, +78%; and amoxicillin/clavulanate, +69%. This increasing use of azithromycin, clarithromycin, and quinolones warrants concern as macrolide- and fluoroquinolone-resistant pneumococci are increasing.

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