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

DOI: 10.1128/AAC.00337-18

Article Figures & Data

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FIG 1
Distribution of antibiotic indices for providers with panel sizes >100 patients. Considerable variation was observed. The median antibiotic index was 84 (dashed line).
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FIG 2
Appropriateness of antibiotic prescribing for the most common outpatient indications. The data highlight that there are vast opportunities for interventions to improve practice and that optimal interventions are likely to differ by indication.

TABLE 1

Inappropriate prescriptions, by antibiotic^a

Antibiotic	No. (%) of prescriptions		Most common reasons for inappropriate prescriptions (n)
Antibiotic	Reviewed	Inappropriate	Most common reasons for inappropriate prescriptions (n)
Amoxicillin-clavulanate	43	30 (69.8)	No indication: ARTI (12), dental (3), otitis externa (3); guideline-discordant agent: UTI (4), SSTI (3)
Amoxicillin	31	19 (61.3)	No indication: ARTI (7), unknown (4), endocarditis prophylaxis (3)
Azithromycin	74	58 (78.4)	No indication: ARTI (33), COPD exacerbation (9), unknown (5); guideline-discordant agent: ARTI (7)
Cephalexin	26	12 (46.2)	No indication: SSTI (9)
Ciprofloxacin	25	21 (84.0)	No indication: UTI (9); guideline-discordant agent: UTI (10)
Doxycycline	33	14 (42.4)	No indication: ARTI (8)
Nitrofurantoin	7	0 (0)
TMP-SMX	28	13 (46.4)	No indication: ARTI (7), UTI (7)

↵a For this analysis, an antibiotic was considered inappropriate if there was no indication for its usage or if the agent chosen was guideline discordant.