title: Outpatient Antibiotic Prescription.
abstract: BACKGROUND
  In view of the rise in antibiotic resistance and Clostridium difficile superinfection, close monitoring of antibiotic prescribing practices is essential so that targeted quality assurance measures can be taken.
  
  
  METHODS
  We analyzed nationwide data from multiple statutory health insurance carriers on prescriptions of systemic antibiotics in the years 2008-2014, with special attention to cephalosporins and fluoroqinolones. Prescribing rates were characterized in terms of defined daily doses (DDD) per 1000 statutory insurees per year and were analyzed separately for each age group and each federal state in Germany. Trends were analyzed with joinpoint regression.
  
  
  RESULTS
  Antibiotic prescribing rates for persons aged 15 to 69 increased slightly overall during the period of observation. On the other hand, there was a significant decline in antibiotic prescribing rates for persons under age 15 in all of the German states, with a mean annual decrease of 6.8%. There was also a slight decline in antibiotic prescribing rates for persons aged 70 and above, mainly accounted for by fluoroquinolones. Cephalosporin prescribing rates rose significantly in all states, by an overall average of 7.6% per annum. Cephalo - sporin prescribing rates rose significantly in all age groups except persons under age 15, for whom there was a decline that did not reach statistical significance.
  
  
  CONCLUSIONS
  This study revealed an overall decline in outpatient antibiotic prescriptions for persons under age 15 as well as other major changes in prescribing practices for the types of antibiotics studied. The observed marked rise in cephalosporin prescribing rates in all German states demands special attention because of the associated danger of increased antibiotic resistance and C. difficile superinfection. Oral cephalosporins are not recommended as drugs of first choice in current guidelines.
authors.affiliation: Central Research Institute of Ambulatory Health Care in Germany (ZI), Berlin, Center of Infectious Diseases and Travel Medicine, Medical Center-University of Freiburg.
authors.forename: Jörg
authors.initials: J
authors.lastname: Bätzing-Feigenbaum
authors.forename: Maike
authors.initials: M
authors.lastname: Schulz
authors.forename: Mandy
authors.initials: M
authors.lastname: Schulz
authors.forename: Ramona
authors.initials: R
authors.lastname: Hering
authors.forename: Winfried V
authors.initials: WV
authors.lastname: Kern
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000517:prevention & control; D002511:Cephalosporins / Q000627:therapeutic use; D002675:Child, Preschool; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data* / Q000639:trends*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones