Antibiotic Rx Highest in Southern States

November 13, 2012

Clinicians in 7 southern states lead the nation in prescribing antibiotics on an outpatient, per capita basis, and at roughly double the rate found in Pacific Coast states, where such rates are the lowest, according to the Center for Disease Dynamics, Economics & Policy (CDDEP).

The think tank released these findings today as part of "Get Smart: Know When Antibiotics Work," a week-long publicity campaign organized by the Centers for Disease Control and Prevention (CDC). Now in its fifth year, Get Smart week aims at curbing the inappropriate use of antibiotics that leads to bacterial resistance and infections that defy treatment.

At a press conference November 13, officials from the CDC, CDDEP, and other Get Smart partners provided a snapshot of the troubling state of antibiotic-resistant pathogens. On the good-news side, the rate of antibiotic prescription declined 17% from 1999 to 2010, and 86% of Americans know they should take a full course of antibiotics rather than stop mid-way, according to a new survey by the Pew Health Group. However, the bad news seems more abundant:

  • The decline in antibiotic use is far less pronounced in the high-consumption states of the South.

  • Drugs used to treat urinary tract infections are gradually losing their effectiveness due to the encroachment of antibiotic resistance. The overall share of resistant bacteria grew by more than 30% between 1999 and 2010, according to the CDDEP.

  • Hard to discover and less profitable than other drugs, new antibiotics have been slow to come to market, reports the Pew Health Group. Drug companies developed 13 new classes of antibiotics between 1935 and 1968, but only 2 since then.

  • Thirty-six percent of Americans mistakenly believe that antibiotics can treat viral infections, and 39% do not believe that their misuse of an antibiotic can weaken the drug's effectiveness for others.

  • While overall antibiotic prescriptions declined 17% from 1999 to 2010, most of the decline reflected less use of penicillin and macrolides. "For the more powerful drugs, prescribing has not really decreased a whole lot," CDDEP Director Ramanan Laxminarayan, PhD, MPH, said at the press conference.

In response to these trends, 26 organizations, including the American Academy of Pediatrics, the Infectious Diseases Society of America, the Society for Hospital Medicine, the CDDEP, and the CDC, have signed a consensus statement pledging themselves to principles that, if followed, will "conserve and replenish our antibiotic resources."

"The days of untreatable infections always loom," said Arjun Srinivasan, MD, associate director for Healthcare Associated Infection Prevention Programs in the CDC's Division of Healthcare Quality Promotion. "How we use and protect these precious drugs must fundamentally change."

Southern States Form Antibiotic Belt

Wide regional variance in antibiotic prescribing illustrate that there is room for improvement in educating patients and physicians about best practices. Nationwide, the rate of outpatient prescriptions for all classes of antibiotics decreased from 966 scripts per 1000 population in 1999 to 801 scripts in 2010. States at the bottom and top of the list were separated by a wide gulf:

Where Clinicians Prescribe Antibiotics Most


Antibiotic prescriptions (all classes) per 1000 population



West Virginia1












Where Clinicians Prescribe Antibiotics Least


Antibiotic prescriptions (all classes) per 1000 population

New Hampshire














1 The Census Bureau classifies West Virginia as a southern state.

Source: Center for Disease Dynamics, Economics & Policy.

"High antibiotic use rates could reflect cultural norms in certain regions where consumers demand antibiotics — and physicians prescribe them — even when they're not needed," the CDDEP's Dr. Laxminarayan surmised in a press release. "Patients in remote areas may desire antibiotics for a cold or the flu…because they have infrequent access to their doctor and want to make sure they get a 'cure' on their visit."

More information on the Get Smart campaign on the appropriate use of antibiotics, including material designed for clinicians, is available on the CDC Web site.