
Electronic health record data from 352 US outpatient facilities show a 20% increase in antibiotic prescribing per year from 2021 through 2023, researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.
Using data from the Collaboration to Harmonize Antimicrobial Registry Measures database, researchers from Ferris State University assessed oral antibiotic prescribing at 352 outpatient facilities in the Midwest from January 2021 through June 2023. The primary outcome was the rate of antibiotic prescribing per 1,000 prescription-related outpatient visits, and secondary outcomes included prescribing patterns for selected diagnoses and the concordance of antibiotic prescriptions with published guidelines.
"By examining this trend, we aim to identify potential gaps in clinical practice and areas for intervention to enhance the judicious use of antibiotics," the study authors wrote.
Return to pre-pandemic healthcare use
Out of 6,795,023 prescription-related outpatient visits over the study period, 823,938 antibiotics prescriptions were issued, for an overall prescribing rate of 121.26 per 1,000 prescription-related visits. The rate increased from 96.24 in the first quarter of 2021, to 114.80 in the same quarter of 2022 (a 19% increase) and further increased to 138.87 in the first quarter of 2023 (a 20% increase from 2022). Amoxicillin-clavulanate (12%), amoxicillin (12%), doxycycline (11%), and cephalexin (11%) were the most frequently prescribed antibiotics.
Sinusitis and otitis media were the most common reasons for prescribing antibiotics among adults and children, respectively. Less than 60% of sinusitis-related prescriptions were antibiotic concordant. Duration concordance rates were less than 70% for sinusitis, urinary tract infections, cellulitis, and group A Streptococci (GAS) infections. The researchers also noted a significant increase in pediatric antibiotic prescriptions, with the prescription rates for otitis media rising by 152% in the last quarter of 2022 and for GAS by 165% in the first quarter of 2023.
The authors say the increase in antibiotic prescribing reflects a return to pre-COVID pandemic healthcare utilization patterns, and resurgence in infections as public health measures were relaxed. They add that the discrepancies in guideline concordance highlight the need for stronger antimicrobial stewardship.
"Future research should focus on understanding the factors influencing prescribing behaviors and developing targeted interventions to promote appropriate antibiotic use," they wrote.