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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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    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.

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  • TABLE 1

    Inappropriate prescriptions, by antibiotica

    AntibioticNo. (%) of prescriptionsMost common reasons for inappropriate prescriptions (n)
    ReviewedInappropriate
    Amoxicillin-clavulanate4330 (69.8)No indication: ARTI (12), dental (3), otitis externa (3); guideline-discordant agent: UTI (4), SSTI (3)
    Amoxicillin3119 (61.3)No indication: ARTI (7), unknown (4), endocarditis prophylaxis (3)
    Azithromycin7458 (78.4)No indication: ARTI (33), COPD exacerbation (9), unknown (5); guideline-discordant agent: ARTI (7)
    Cephalexin2612 (46.2)No indication: SSTI (9)
    Ciprofloxacin2521 (84.0)No indication: UTI (9); guideline-discordant agent: UTI (10)
    Doxycycline3314 (42.4)No indication: ARTI (8)
    Nitrofurantoin70 (0)
    TMP-SMX2813 (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.

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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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