title: Inappropriate antibiotic prescribing in managed care subjects with influenza.
abstract: OBJECTIVE
  To evaluate costs of inappropriate oral antibiotic prescribing in a managed care population with influenza.
  
  
  METHODS
  This was a retrospective (January 1, 2005, through December 31, 2009) analysis of the US Impact National Benchmark Database. Patients with an influenza diagnosis (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 487.xx) and continuous health plan enrollment for >12 months before and 1 month after the index influenza diagnosis date were included. We identified patients with an antibiotic prescription claim within 3 days before or 3 days after the index influenza diagnosis date. Patients were classified as having received appropriate antibiotic treatment if a secondary respiratory infection was observed within the 2-week postindex period or if there was a previous comorbid diagnosis of diabetes, congestive heart failure, chronic obstructive pulmonary disease, asthma, acute myocardial infarction, or sickle cell anemia as identified by ICD-9-CM codes.
  
  
  RESULTS
  We identified 270,057 subjects with influenza (mean age, 31.6 years). Antibiotics were prescribed in 58,477 (21.65%) patients. Among patients receiving antibiotics, 99% did not have a follow-up diagnosis for a respiratory bacterial infection and 79% had neither a secondary infection nor evidence of a comorbidity (ie, received inappropriate antibiotic treatment). Based on a conservative annual seasonal influenza rate of 10%, we estimated that inappropriate antibiotic prescribing for influenza costs the United States approximately $211 million annually.
  
  
  CONCLUSIONS
  Empiric antibiotics were inappropriately prescribed in a high percentage of influenza patients. This represents a significant financial burden to the US healthcare system and may contribute to increased antibiotic resistance.
authors: GlaxoSmith-Kline, 200 N 16th St, Philadelphia, PA 19102, USA. derek.a.misurski@gsk.com
authors: Derek A
authors: DA
authors: Misurski
authors: David A
authors: DA
authors: Lipson
authors: Arun K
authors: AK
authors: Changolkar
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D016208:Databases, Factual; D005260:Female; D017048:Health Care Costs; D006801:Humans; D057970:Inappropriate Prescribing / Q000191:economics* / Q000706:statistics & numerical data; D007251:Influenza, Human / Q000188:drug therapy* / Q000191:economics; D008137:Longitudinal Studies; D008297:Male; D008329:Managed Care Programs / Q000191:economics* / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents