title: Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011.
abstract: OBJECTIVE
  The National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal of reducing inappropriate outpatient antibiotic use by 50% by 2020, but the extent of inappropriate outpatient antibiotic use is unknown.
  
  
  OBJECTIVE
  To estimate the rates of outpatient oral antibiotic prescribing by age and diagnosis, and the estimated portions of antibiotic use that may be inappropriate in adults and children in the United States.
  
  
  METHODS
  Using the 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, annual numbers and population-adjusted rates with 95% confidence intervals of ambulatory visits with oral antibiotic prescriptions by age, region, and diagnosis in the United States were estimated.
  
  
  METHODS
  Ambulatory care visits.
  
  
  METHODS
  Based on national guidelines and regional variation in prescribing, diagnosis-specific prevalence and rates of total and appropriate antibiotic prescriptions were determined. These rates were combined to calculate an estimate of the appropriate annual rate of antibiotic prescriptions per 1000 population.
  
  
  RESULTS
  Of the 184,032 sampled visits, 12.6% of visits (95% CI, 12.0%-13.3%) resulted in antibiotic prescriptions. Sinusitis was the single diagnosis associated with the most antibiotic prescriptions per 1000 population (56 antibiotic prescriptions [95% CI, 48-64]), followed by suppurative otitis media (47 antibiotic prescriptions [95% CI, 41-54]), and pharyngitis (43 antibiotic prescriptions [95% CI, 38-49]). Collectively, acute respiratory conditions per 1000 population led to 221 antibiotic prescriptions (95% CI, 198-245) annually, but only 111 antibiotic prescriptions were estimated to be appropriate for these conditions. Per 1000 population, among all conditions and ages combined in 2010-2011, an estimated 506 antibiotic prescriptions (95% CI, 458-554) were written annually, and, of these, 353 antibiotic prescriptions were estimated to be appropriate antibiotic prescriptions.
  
  
  CONCLUSIONS
  In the United States in 2010-2011, there was an estimated annual antibiotic prescription rate per 1000 population of 506, but only an estimated 353 antibiotic prescriptions were likely appropriate, supporting the need for establishing a goal for outpatient antibiotic stewardship.
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Fleming-Dutra
authors.affiliation: Pediatric Infectious Diseases, University of Utah, Salt Lake City.
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
authors.affiliation: School of Medicine, University of California, San Francisco, San Francisco.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Shapiro
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Monina
authors.initials: M
authors.lastname: Bartoces
authors.affiliation: Division of Health Policy and Management, University of Minnesota, Minneapolis.
authors.forename: Eva A
authors.initials: EA
authors.lastname: Enns
authors.affiliation: Summa Health System and Northeast Ohio Medical University, Akron.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: File
authors.affiliation: Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Finkelstein
authors.affiliation: Children's Hospital of Philadelphia, Philadelphia, Pennsylvania8University of Pennsylvania Perelman School of Medicine, Philadelphia.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerber
authors.affiliation: Pew Charitable Trusts, Washington, DC.
authors.forename: David Y
authors.initials: DY
authors.lastname: Hyun
authors.affiliation: Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Linder
authors.affiliation: Minnesota Department of Health, St Paul.
authors.forename: Ruth
authors.initials: R
authors.lastname: Lynfield
authors.affiliation: University of Pennsylvania Perelman School of Medicine, Philadelphia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Margolis
authors.affiliation: Department of Emergency Medicine, University of California-Davis, Sacramento.
authors.forename: Larissa S
authors.initials: LS
authors.lastname: May
authors.affiliation: Department of Family Medicine, Georgetown University Medical Center, Washington, DC.
authors.forename: Daniel
authors.initials: D
authors.lastname: Merenstein
authors.affiliation: Division of General Internal Medicine, Massachusetts General Hospital, Boston.
authors.forename: Joshua P
authors.initials: JP
authors.lastname: Metlay
authors.affiliation: Division of Pediatric Infectious Diseases, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Jason G
authors.initials: JG
authors.lastname: Newland
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Jay F
authors.initials: JF
authors.lastname: Piccirillo
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Rebecca M
authors.initials: RM
authors.lastname: Roberts
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Guillermo V
authors.initials: GV
authors.lastname: Sanchez
authors.affiliation: Department of Veterans Affairs, University of Illinois at Chicago, Chicago.
authors.forename: Katie J
authors.initials: KJ
authors.lastname: Suda
authors.affiliation: Oregon Public Health Division, Portland.
authors.forename: Ann
authors.initials: A
authors.lastname: Thomas
authors.affiliation: Pacific Lutheran University, Tacoma, Washington.
authors.forename: Teri Moser
authors.initials: TM
authors.lastname: Woo
authors.affiliation: Pew Charitable Trusts, Washington, DC.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Zetts
authors.affiliation: Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Lauri A
authors.initials: LA
authors.lastname: Hicks
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D057970:Inappropriate Prescribing / Q000706:statistics & numerical data*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010035:Otitis Media, Suppurative / Q000188:drug therapy*; D010612:Pharyngitis / Q000188:drug therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D012141:Respiratory Tract Infections / Q000188:drug therapy; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents