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Epidemiology and Surveillance

Prevalence of Inappropriate Antibiotic Prescribing in Primary Care Clinics within a Veterans Affairs Health Care System

Nathan R. Shively, Deanna J. Buehrle, Cornelius J. Clancy, Brooke K. Decker
Nathan R. Shively
aDivision of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Deanna J. Buehrle
bInfectious Diseases Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Cornelius J. Clancy
aDivision of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
bInfectious Diseases Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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Brooke K. Decker
aDivision of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
bInfectious Diseases Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
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DOI: 10.1128/AAC.00337-18
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ABSTRACT

Data are needed from outpatient settings to better inform antimicrobial stewardship. In this study, a random sample of outpatient antibiotic prescriptions by primary care providers (PCPs) at our health care system was reviewed and compared to consensus guidelines. Over 12 months, 3,880 acute antibiotic prescriptions were written by 76 PCPs caring for 40,734 patients (median panel, 600 patients; range, 33 to 1,547). PCPs ordered a median of 84 antibiotic prescriptions per 1,000 patients per year. Azithromycin (25.8%), amoxicillin-clavulanate (13.3%), doxycycline (12.4%), amoxicillin (11%), fluoroquinolones (11%), and trimethoprim-sulfamethoxazole (10.6%) were prescribed most commonly. Medical records corresponding to 300 prescriptions from 59 PCPs were analyzed in depth. The most common indications for these prescriptions were acute respiratory tract infection (28.3%), urinary tract infection (23%), skin and soft tissue infection (15.7%), and chronic obstructive pulmonary disease (COPD) exacerbation (6.3%). In 5.7% of cases, no reason for the prescription was listed. No antibiotic was indicated in 49.7% of cases. In 12.3% of cases, an antibiotic was indicated, but the prescribed agent was guideline discordant. In another 14% of cases, a guideline-concordant antibiotic was given for a guideline-discordant duration. Therefore, 76% of reviewed prescriptions were inappropriate. Ciprofloxacin and azithromycin were most likely to be prescribed inappropriately. A non-face-to-face encounter prompted 34% of prescriptions. The condition for which an antibiotic was prescribed was not listed in primary or secondary diagnosis codes in 54.5% of clinic visits. In conclusion, there is an enormous opportunity to reduce inappropriate outpatient antibiotic prescriptions.

FOOTNOTES

    • Received 17 February 2018.
    • Returned for modification 22 March 2018.
    • Accepted 5 June 2018.
    • Accepted manuscript posted online 2 July 2018.
  • Supplemental material for this article may be found at https://doi.org/10.1128/AAC.00337-18.

  • Copyright © 2018 American Society for Microbiology.

All Rights Reserved.

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Prevalence of Inappropriate Antibiotic Prescribing in Primary Care Clinics within a Veterans Affairs Health Care System
Nathan R. Shively, Deanna J. Buehrle, Cornelius J. Clancy, Brooke K. Decker
Antimicrobial Agents and Chemotherapy Jul 2018, 62 (8) e00337-18; DOI: 10.1128/AAC.00337-18

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Prevalence of Inappropriate Antibiotic Prescribing in Primary Care Clinics within a Veterans Affairs Health Care System
Nathan R. Shively, Deanna J. Buehrle, Cornelius J. Clancy, Brooke K. Decker
Antimicrobial Agents and Chemotherapy Jul 2018, 62 (8) e00337-18; DOI: 10.1128/AAC.00337-18
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KEYWORDS

antimicrobial stewardship
inappropriate prescribing
outpatient
prescribing patterns
primary care

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