Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011
Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011
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DOI：
10.1001/jama.2016.4151
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发表时间：
2016-05-03
影响因子：
120.7
通讯作者：
Hicks, Lauri A.
中科院分区：
文献类型：
--
作者：
Fleming-Dutra, Katherine E.;Hersh, Adam L.;Hicks, Lauri A.
重要性国家对抗抗生素耐药菌行动计划设定了到2020年将门诊抗生素不适当使用减少50%的目标，但门诊抗生素不适当使用的程度尚不清楚。目的估计按年龄和诊断划分的门诊口服抗生素处方率，以及美国成人和儿童可能不适当使用抗生素的估计比例。使用2010-2011年全国门诊医疗调查和全国医院门诊医疗调查，按年龄、地区、年龄、年龄主要结果和指标根据国家指南和地区指南，确定了处方的变化、诊断特异性患病率以及总的和适当的抗生素处方率。将这些比率结合起来，以计算每1000人中抗生素处方的适当年比率的估计值。结果在184032次抽样访问中，12.6%的访问（95%CI，12.0%-13.3%）导致抗生素处方。鼻窦炎是与每1000人中最多抗生素处方相关的单一诊断（56个抗生素处方[95% CI，48-64]），其次是化脓性中耳炎（47个抗生素处方[95% CI，41-54]）和咽炎（43个抗生素处方[95% CI，38-49]）。总的来说，每1000人中的急性呼吸系统疾病每年导致221例抗生素处方（95% CI，198-245），但估计只有111例抗生素处方适用于这些疾病。2010-2011年，每1000人中，在所有条件和年龄中，估计有506个抗生素处方（95%CI，458-554），其中，353个抗生素处方被估计为适当的抗生素处方。估计每1000人的抗生素年处方率为506，但估计只有353个抗生素处方可能是适当的，这支持了建立门诊抗生素管理目标的必要性。
IMPORTANCE 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.DESIGN, SETTING, AND PARTICIPANTS 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.EXPOSURES Ambulatory care visits.MAIN OUTCOMES AND MEASURES 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 AND RELEVANCE 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.