Antimicrobial Drug Prescriptions in Ambulatory-Care Settings
Antimicrobial Drug Prescriptions in Ambulatory-Care Settings
During the 1990s, as antimicrobial resistance increased among pneumococci, many organizations promoted appropriate antimicrobial use to combat resistance. We analyzed data from the National Ambulatory Medical Care Survey, an annual sample survey of visits to office-based physicians, and the National Hospital Ambulatory Medical Care Survey, an annual sample survey of visits to hospital emergency and outpatient departments, to describe trends in antimicrobial prescribing from 1992 to 2000 in the United States. Approximately 1,100-1,900 physicians reported data from 21,000-37,000 visits; 200-300 outpatient departments reported data for 28,000-35,000 visits; ~400 emergency departments reported data for 21,000-36,000 visits each year. In that period, the population- and visit-based antimicrobial prescribing rates in ambulatory care settings decreased by 23% and 25%, respectively, driven largely by a decrease in prescribing by office-based physicians. Antimicrobial prescribing rates changed as follows: amoxicillin and ampicillin, -43%; cephalosporins, -28%; erythromycin, -76%; azithromycin and clarithromycin, +388%; quinolones, +78%; and amoxicillin/clavulanate, +69%. This increasing use of azithromycin, clarithromycin, and quinolones warrants concern as macrolide- and fluoroquinolone-resistant pneumococci are increasing.
With the emergence of antimicrobial resistance, the use of antimicrobial drugs has increased in both inpatient and outpatient settings. From 1995 through 1998, the overall proportion of isolates of Streptococcus pneumoniae, a community-acquired pathogen, that were resistant to three or more antimicrobial drug classes rose substantially, and high rates of antimicrobial use for upper respiratory tract infections are believed to be a major factor responsible for this increase. Although the overall antimicrobial prescribing rate by office-based physicians in the United States did not change from 1980 through 1992, the rate for children rose by 48%, and in 1992, antimicrobial agents were prescribed second in frequency behind cardiovascular-renal drugs in physicians' offices. Moreover, in the early 1990s, a sizable proportion of antibiotic prescriptions provided by office-based physicians to both children and adults were for colds, upper respiratory tract infections, and bronchitis, for which these drugs have little or no benefit.
During the 1990s, many organizations (e.g., the Centers for Disease Control and Prevention [CDC], American Academy of Pediatrics, American Academy of Family Practice, American Society of Microbiology, and Alliance for the Prudent Use of Antibiotics), conducted campaigns to promote appropriate antimicrobial use, defined by CDC as use that maximizes therapeutic impact while minimizing toxicity and the development of resistance. As a result of these and other efforts and increased media attention to the problem of antimicrobial resistance, antimicrobial prescribing for children seen in physician offices with respiratory infections decreased from 1989 through 2000.
The objective of this study was to describe trends in antimicrobial prescribing at visits to office-based physicians, hospital outpatient departments, and hospital emergency departments in the United States. The results are based on a secondary data analysis using the 1992-2000 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS).
During the 1990s, as antimicrobial resistance increased among pneumococci, many organizations promoted appropriate antimicrobial use to combat resistance. We analyzed data from the National Ambulatory Medical Care Survey, an annual sample survey of visits to office-based physicians, and the National Hospital Ambulatory Medical Care Survey, an annual sample survey of visits to hospital emergency and outpatient departments, to describe trends in antimicrobial prescribing from 1992 to 2000 in the United States. Approximately 1,100-1,900 physicians reported data from 21,000-37,000 visits; 200-300 outpatient departments reported data for 28,000-35,000 visits; ~400 emergency departments reported data for 21,000-36,000 visits each year. In that period, the population- and visit-based antimicrobial prescribing rates in ambulatory care settings decreased by 23% and 25%, respectively, driven largely by a decrease in prescribing by office-based physicians. Antimicrobial prescribing rates changed as follows: amoxicillin and ampicillin, -43%; cephalosporins, -28%; erythromycin, -76%; azithromycin and clarithromycin, +388%; quinolones, +78%; and amoxicillin/clavulanate, +69%. This increasing use of azithromycin, clarithromycin, and quinolones warrants concern as macrolide- and fluoroquinolone-resistant pneumococci are increasing.
With the emergence of antimicrobial resistance, the use of antimicrobial drugs has increased in both inpatient and outpatient settings. From 1995 through 1998, the overall proportion of isolates of Streptococcus pneumoniae, a community-acquired pathogen, that were resistant to three or more antimicrobial drug classes rose substantially, and high rates of antimicrobial use for upper respiratory tract infections are believed to be a major factor responsible for this increase. Although the overall antimicrobial prescribing rate by office-based physicians in the United States did not change from 1980 through 1992, the rate for children rose by 48%, and in 1992, antimicrobial agents were prescribed second in frequency behind cardiovascular-renal drugs in physicians' offices. Moreover, in the early 1990s, a sizable proportion of antibiotic prescriptions provided by office-based physicians to both children and adults were for colds, upper respiratory tract infections, and bronchitis, for which these drugs have little or no benefit.
During the 1990s, many organizations (e.g., the Centers for Disease Control and Prevention [CDC], American Academy of Pediatrics, American Academy of Family Practice, American Society of Microbiology, and Alliance for the Prudent Use of Antibiotics), conducted campaigns to promote appropriate antimicrobial use, defined by CDC as use that maximizes therapeutic impact while minimizing toxicity and the development of resistance. As a result of these and other efforts and increased media attention to the problem of antimicrobial resistance, antimicrobial prescribing for children seen in physician offices with respiratory infections decreased from 1989 through 2000.
The objective of this study was to describe trends in antimicrobial prescribing at visits to office-based physicians, hospital outpatient departments, and hospital emergency departments in the United States. The results are based on a secondary data analysis using the 1992-2000 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS).
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