Antibiotic prescription rates for acute respiratory tract infections in US ambulatory settings.

CONTEXT During the 1990s, antibiotic prescriptions for acute respiratory tract infection (ARTI) decreased in the United States. The sustainability of those changes is unknown. OBJECTIVE To assess trends in antibiotic prescriptions for ARTI. DESIGN, SETTING, AND PARTICIPANTS The National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data (1995-2006) were used to examine trends in antibiotic prescription rates by antibiotic indication and class. Annual survey data and census denominators were combined in 2-year intervals for rate calculations. MAIN OUTCOME MEASURES National annual visit rates and antibiotic prescription rates for ARTI, including otitis media (OM) and non-ARTI. RESULTS Among children younger than 5 years, annual ARTI visit rates decreased by 17% (95% confidence interval [CI], 9%-24%), from 1883 per 1000 population in 1995-1996 to 1560 per 1000 population in 2005-2006, primarily due to a 33% (95% CI, 22%-43%) decrease in OM visit rates (950 to 634 per 1000 population, respectively). This decrease was accompanied by a 36% (95% CI, 26%-45%) decrease in ARTI-associated antibiotic prescriptions (1216 to 779 per 1000 population). Among persons aged 5 years or older, ARTI visit rates remained stable but associated antibiotic prescription rates decreased by 18% (95% CI, 6%-29%), from 178 to 146 per 1000 population. Antibiotic prescription rates for non-OM ARTI for which antibiotics are rarely indicated decreased by 41% (95% CI, 22%-55%) and 24% (95% CI, 10%-37%) among persons younger than 5 years and 5 years or older, respectively. Overall, ARTI-associated prescription rates for penicillin, cephalosporin, and sulfonamide/tetracycline decreased. Prescription rates for azithromycin increased and it became the most commonly prescribed macrolide for ARTI and OM (10% of OM visits). Among adults, quinolone prescriptions increased. CONCLUSIONS Overall antibiotic prescription rates for ARTI decreased, associated with fewer OM visits in children younger than 5 years and with fewer prescriptions for ARTI for which antibiotics are rarely indicated. However, prescription rates for broad-spectrum antibiotics increased significantly.

[1]  K. Klugman,et al.  Hidden Epidemic of Macrolide-resistant Pneumococci , 2005, Emerging infectious diseases.

[2]  J. Bartlett,et al.  The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[3]  S. Schrag,et al.  Emergence of levofloxacin-non-susceptible Streptococcus pneumoniae and treatment for multidrug-resistant tuberculosis in children in South Africa: a cohort observational surveillance study , 2008, The Lancet.

[4]  R. Duncan,et al.  Diagnosis and Management of Acute Otitis Media , 2019, Jurnal Penelitian Perawat Profesional.

[5]  A. Mitchell,et al.  Management of Acute Otitis Media by Primary Care Physicians: Trends Since the Release of the 2004 American Academy of Pediatrics/American Academy of Family Physicians Clinical Practice Guideline , 2007, Pediatrics.

[6]  Robert S. Dittus,et al.  Trends in antibiotic prescribing for adults in the United States—1995 to 2002 , 2005, Journal of General Internal Medicine.

[7]  J. Lieberman.  Appropriate antibiotic use and why it is important: the challenges of bacterial resistance , 2003, The Pediatric infectious disease journal.

[8]  A. Shefer,et al.  Health care utilization for pneumonia in young children after routine pneumococcal conjugate vaccine use in the United States. , 2007, Archives of pediatrics & adolescent medicine.

[9]  D. Bates,et al.  Antivirals and antibiotics for influenza in the United States, 1995–2002 , 2005, Pharmacoepidemiology and drug safety.

[10]  Stella M. Yu.  Healthy People 2010 , 1998, Maternal and Child Health Journal.

[11]  S. Dowell,et al.  Appropriate use of antibiotics for URIs in children: Part II. Cough, pharyngitis and the common cold. The Pediatric URI Consensus Team. , 1998, American family physician.

[12]  B. LaFleur,et al.  Reduction of Frequent Otitis Media and Pressure-Equalizing Tube Insertions in Children After Introduction of Pneumococcal Conjugate Vaccine , 2007, Pediatrics.

[13]  R. Stafford,et al.  Fluoroquinolone prescribing in the United States: 1995 to 2002. , 2005, The American journal of medicine.

[14]  C. Butler,et al.  The role of evidence in the decline of antibiotic use for common respiratory infections in primary care. , 2007, The Lancet. Infectious diseases.

[15]  J. Bartlett,et al.  Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[16]  A. Go,et al.  Reduction in antibiotic use among US children, 1996-2000. , 2003, Pediatrics.

[17]  Victor L. Yu,et al.  Medical Section pf the American Lung Association: Guidelines for the Initial Management of Adults with Community-acquired Pneumonia: Diagnosis, Assessment of Severity, and Initial Antimicrobial Therapy , 1993 .

[18]  R. Besser,et al.  Promoting appropriate antibiotic use for pediatric patients: a social ecological framework. , 2004, Seminars in pediatric infectious diseases.

[19]  Ralph Gonzales,et al.  Changing Use of Antibiotics in Community-Based Outpatient Practice, 19911999 , 2003, Annals of Internal Medicine.

[20]  G. Doern.  Macrolide and ketolide resistance with Streptococcus pneumoniae. , 2006, The Medical clinics of North America.

[21]  Y. Hirakata,et al.  Increasing prevalence of antimicrobial resistance among isolates of Streptococcus pneumoniae from the PROTEKT surveillance study, and compatative in vitro activity of the ketolide, telithromycin. , 2002, The Journal of antimicrobial chemotherapy.

[22]  R. Besser.  Antimicrobial Prescribing in the United States: Good News, Bad News , 2003, Annals of Internal Medicine.

[23]  M. Laopaiboon,et al.  Azithromycin for acute lower respiratory tract infections. , 2008, The Cochrane database of systematic reviews.

[24]  W. Schaffner,et al.  Effect of introduction of the pneumococcal conjugate vaccine on drug-resistant Streptococcus pneumoniae. , 2006, The New England journal of medicine.

[25]  S. Black.  Changing epidemiology of invasive pneumococcal disease: a complicated story. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[26]  K. Kafadar,et al.  “Get Smart Colorado”: Impact of a Mass Media Campaign to Improve Community Antibiotic Use , 2008, Medical care.

[27]  P. Arbogast,et al.  Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: a time-series analysis , 2007, The Lancet.

[28]  S. McKenna,et al.  Macrolides: A Canadian Infectious Disease Society position paper. , 2001, The Canadian journal of infectious diseases = Journal canadien des maladies infectieuses.

[29]  J. Hughes,et al.  Trends in antimicrobial prescribing rates for children and adolescents. , 2002, JAMA.

[30]  S. Dowell,et al.  Appropriate use of antibiotics for URIs in children: Part I. Otitis media and acute sinusitis. The Pediatric URI Consensus Team. , 1998, American family physician.

[31]  K. Edwards,et al.  Decreased number of antibiotic prescriptions in office-based settings from 1993 to 1999 in children less than five years of age , 2002, The Pediatric infectious disease journal.

[32]  Karen L. Ytterberg,et al.  A program of anticipatory guidance for the prevention of emergency department visits for ear pain. , 2008, Archives of pediatrics & adolescent medicine.

[33]  K. Poehling,et al.  National Impact of Universal Childhood Immunization With Pneumococcal Conjugate Vaccine on Outpatient Medical Care Visits in the United States , 2006, Pediatrics.

[34]  J. Stockman.  Reduction of Frequent Otitis Media and Pressure-Equalizing Tube Insertions in Children After Introduction of Pneumococcal Conjugate Vaccine , 2008 .

[35]  Keiji Fukuda,et al.  Influenza-associated hospitalizations in the United States. , 2004, JAMA.

[36]  S. Dowell,et al.  Principles of Judicious Use of Antimicrobial Agents for Pediatric Upper Respiratory Tract Infections , 1998, Pediatrics.

[37]  Susan R. Johnson,et al.  Macrolide Resistance among Invasive Streptococcus Pneumoniae Isolates , 2022 .

[38]  D. Greenberg,et al.  Introduction and proliferation of multidrug-resistant Streptococcus pneumoniae serotype 19A clones that cause acute otitis media in an unvaccinated population. , 2009, The Journal of infectious diseases.

[39]  V L Yu,et al.  Guidelines for the initial management of adults with community-acquired pneumonia: diagnosis, assessment of severity, and initial antimicrobial therapy. American Thoracic Society. Medical Section of the American Lung Association. , 1993 .

[40]  R. Propp,et al.  Watchful Waiting for Acute Otitis Media: Are Parents and Physicians Ready? , 2006, Pediatrics.

[41]  W. Schaffner,et al.  Population snapshot of emergent Streptococcus pneumoniae serotype 19A in the United States, 2005. , 2008, The Journal of infectious diseases.

[42]  M. Laopaiboon,et al.  Azithromycin for acute lower respiratory tract infections. , 2015, The Cochrane database of systematic reviews.

[43]  J. Stockman.  Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: a time-series analysis , 2009 .

[44]  A. Karchmer.  Increased antibiotic resistance in respiratory tract pathogens: PROTEKT US--an update. , 2004, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[45]  A. Shefer,et al.  Trends in Acute Otitis Media-Related Health Care Utilization by Privately Insured Young Children in the United States, 1997–2004 , 2008, Pediatrics.

[46]  Ralph Gonzales,et al.  Predictors of broad-spectrum antibiotic prescribing for acute respiratory tract infections in adult primary care. , 2003, JAMA.

[47]  R. Platt,et al.  Impact of a 16-Community Trial to Promote Judicious Antibiotic Use in Massachusetts , 2008, Pediatrics.

[48]  R. Jacobs.  Judicious use of antibiotics for common pediatric respiratory infections , 2000, The Pediatric infectious disease journal.

[49]  K. O'Brien,et al.  Changing epidemiology of invasive pneumococcal disease among White Mountain Apache persons in the era of the pneumococcal conjugate vaccine. , 2008, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[50]  J. Hughes,et al.  Antimicrobial-Drug Prescription in Ambulatory Care Settings, United States, 1992–2000 , 2003, Emerging infectious diseases.