Trends in outpatient antibiotic use and prescribing practice among US older adults, 2011-15: observational study

被引:59
作者
Olesen, Scott W. [1 ]
Barnett, Michael L. [2 ,3 ]
MacFadden, Derek R. [4 ,5 ]
Lipsitch, Marc [1 ,5 ]
Grad, Yonatan H. [1 ,6 ]
机构
[1] Harvard TH Chan Sch Publ Hlth, Dept Immunol & Infect Dis, Boston, MA 02115 USA
[2] Harvard TH Chan Sch Publ Hlth, Dept Hlth Policy & Management, Boston, MA USA
[3] Harvard Med Sch, Brigham & Womens Hosp, Div Gen Internal Med & Primary Care, Dept Med, Boston, MA USA
[4] Univ Toronto, Div Infect Dis, Dept Med, Toronto, ON, Canada
[5] Harvard TH Chan Sch Publ Hlth, Dept Epidemiol, Ctr Communicable Dis Dynam, Boston, MA USA
[6] Harvard Med Sch, Brigham & Womens Hosp, Div Infect Dis, Boston, MA 02115 USA
来源
BMJ-BRITISH MEDICAL JOURNAL | 2018年 / 362卷
关键词
UNITED-STATES; PATIENT; CONSUMPTION; INFECTIONS; RESISTANCE; PROVIDER; CARE;
D O I
10.1136/bmj.k3155
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
OBJECTIVE To identify temporal trends in outpatient antibiotic use and antibiotic prescribing practice among older adults in a high income country. DESIGN Observational study using United States Medicare administrative claims in 2011-15. SETTING Medicare, a US national healthcare program for which 98% of older adults are eligible. PARTICIPANTS 4.5 million fee-for-service Medicare beneficiaries aged 65 years old and older. MAIN OUTCOME MEASURES Overall rates of antibiotic prescription claims, rates of potentially appropriate and inappropriate prescribing, rates for each of the most frequently prescribed antibiotics, and rates of antibiotic claims associated with specific diagnoses. Trends in antibiotic use were estimated by multivariable regression adjusting for beneficiaries' demographic and clinical covariates. RESULTS The number of antibiotic claims fell from 1364.7 to 1309.3 claims per 1000 beneficiaries per year in 2011-14 (adjusted reduction of 2.1% (95% confidence interval 2.0% to 2.2%)), but then rose to 1364.3 claims per 1000 beneficiaries per year in 2015 (adjusted reduction of 0.20% over 201115 (0.09% to 0.30%)). Potentially inappropriate antibiotic claims fell from 552.7 to 522.1 per 1000 beneficiaries over 2011- 14, an adjusted reduction of 3.9% (3.7% to 4.1%). Individual antibiotics had heterogeneous changes in use. For example, azithromycin claims per beneficiary decreased by 18.5% (18.2% to 18.8%) while levofloxacin claims increased by 27.7% (27.2% to 28.3%). Azithromycin use associated with each of the potentially appropriate and inappropriate respiratory diagnoses decreased, while levofloxacin use associated with each of those diagnoses increased. CONCLUSIONS Among US Medicare beneficiaries, overall antibiotic use and potentially inappropriate use in 2011- 15 remained steady or fell modestly, but individual drugs had divergent changes in use. Trends in drug use across indications were stronger than trends in use for individual indications, suggesting that guidelines and concerns about antibiotic resistance were not major drivers of change in antibiotic use.
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共 41 条
[1]   Off-label use of oral fluoroquinolone antibiotics in outpatient settings in the United States, 2006 to 2012 [J].
Almalki, Ziyad S. ;
Alahmari, Abdullah K. ;
Guo, Jeff J. ;
Cavanaugh, Teresa M. .
PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, 2016, 25 (09) :1042-1051
[2]  
[Anonymous], ANT PRESCR US US
[3]  
[Anonymous], 2012, COD TRENDS MED EV MA
[4]  
[Anonymous], 2017, ANT PRESCR FILL RAT
[5]  
[Anonymous], EMERG INFECT DIS
[6]  
[Anonymous], 2016, FDA Drug Safety Communication: FDA strengthens warnings and changes prescribing instructions to decrease the risk of serious allergic reactions with anemia drug Feraheme
[7]   Regional variation in antibiotic prescribing among medicare part D enrollees, 2013 [J].
Arizpe, Andre ;
Reveles, Kelly R. ;
Aitken, Samuel L. .
BMC INFECTIOUS DISEASES, 2016, 16
[8]   Antibiotic Prescribing for Adults With Acute Bronchitis in the United States, 1996-2010 [J].
Barnett, Michael L. ;
Linder, Jeffrey A. .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2014, 311 (19) :2020-2022
[9]   Antibiotic Prescribing to Adults With Sore Throat in the United States, 1997-2010 [J].
Barnett, Michael L. ;
Linder, Jeffrey A. .
JAMA INTERNAL MEDICINE, 2014, 174 (01) :138-140
[10]   Antibiotic resistance - Squeezing the balloon? [J].
Burke, JP .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1998, 280 (14) :1270-1271