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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 decreasing annual antimicrobial prescribing rates by drug class—United States, 1992–2000. Note: all trends shown are significant (p<0.001).
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Figure 5: Trends in decreasing annual antimicrobial prescribing rates by drug class—United States, 1992–2000. Note: all trends shown are significant (p<0.001).

Mentions: During the study period, the antimicrobial prescribing rate at all ambulatory care visits declined for amoxicillin and ampicillin (–43%;p<0.001), cephalosporins (–28%; p<0.001), and erythromycin (–76%; p<0.001) (Figure 5); the prescribing rate rose for azithromycin and clarithromycin (+388%; p<0.001), quinolones among persons >15 years (+78%; p<0.001), and amoxicillin/clavulanate among children <15 years (+72%; p=0.004) (Figure 6). Decreasing trends were also found for other penicillins (p<0.001), tetracyclines (p<0.001), and trimethoprim-sulfamethoxazole (p=0.009) (data not shown). Table 2 shows the rank order of the nine drug classes examined in 1992 compared with their order in 2000.


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

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

Trends in decreasing annual antimicrobial prescribing rates by drug class—United States, 1992–2000. Note: all trends shown are significant (p<0.001).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2957974&req=5

Figure 5: Trends in decreasing annual antimicrobial prescribing rates by drug class—United States, 1992–2000. Note: all trends shown are significant (p<0.001).
Mentions: During the study period, the antimicrobial prescribing rate at all ambulatory care visits declined for amoxicillin and ampicillin (–43%;p<0.001), cephalosporins (–28%; p<0.001), and erythromycin (–76%; p<0.001) (Figure 5); the prescribing rate rose for azithromycin and clarithromycin (+388%; p<0.001), quinolones among persons >15 years (+78%; p<0.001), and amoxicillin/clavulanate among children <15 years (+72%; p=0.004) (Figure 6). Decreasing trends were also found for other penicillins (p<0.001), tetracyclines (p<0.001), and trimethoprim-sulfamethoxazole (p=0.009) (data not shown). Table 2 shows the rank order of the nine drug classes examined in 1992 compared with their order in 2000.

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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