Inappropriate Antibiotic Rx Common in Privately Insured
Only 12.8 and 35.5 percent of fills were appropriate, potentially appropriate in outpatients
FRIDAY, Jan. 18, 2019 (Pharmacist's Briefing) -- Less than half of all outpatient antibiotic prescription fills by privately insured nonelderly adults and children in the United States are appropriate or potentially appropriate, according to a study published online Jan. 16 in The BMJ.
Kao-Ping Chua, M.D., Ph.D., from the University of Michigan Medical School in Ann Arbor, and colleagues conducted a cross-sectional study involving 19.2 million enrollees aged 0 to 64 years to assess the appropriateness of outpatient antibiotic prescribing for privately insured children and nonelderly adults. A classification scheme was developed to determine whether the International Classification of Diseases-clinical modification-10th revision diagnosis codes always, sometimes, or never justified antibiotics. The cohort of 19,203,264 individuals included 14,571,944 adults with a total of 15,455,834 outpatient antibiotic prescription fills for the cohort.
The researchers found that the most common antibiotics prescribed were azithromycin, amoxicillin, and amoxicillin-clavulanate (19, 18.2, and 11.6 percent, respectively). Overall, 12.8 and 35.5 percent of antibiotic fills were appropriate and potentially appropriate, respectively; 23.2 percent were inappropriate; and 28.5 percent were not associated with a recent diagnosis code. Of the inappropriate fills, 70.7, 6.2, and 4.7 percent were written in office-based settings, urgent care centers, and emergency departments, respectively. In 2016, 14.1 percent of the enrollees filled at least one inappropriate antibiotic prescription, including 10.6 and 15.2 percent of children and adults, respectively.
"Our results show the scale of inappropriate antibiotic prescribing at both the prescription and population levels," the authors write.