The Who, What, and Where of Outpatient Antibiotic Prescribing

Jennifer H. Han, MD, MSCE


June 30, 2015

Editorial Collaboration

Medscape &

US Outpatient Antibiotic Prescribing Variation According to Geography, Patient Population, and Provider Specialty in 2011

Hicks LA, Bartoces MG, Roberts RM, et al
Clin Infect Dis. 2015;60:1308-1316

Prescribing Patterns

Two large, comprehensive studies recently highlighted significant variability in US outpatient antibiotic prescribing as well as the importance of antibiotic stewardship interventions targeting this setting in combating antibiotic resistance.

Hicks and colleagues conducted a comprehensive overview of outpatient antibiotic prescription patterns in the United States. The investigators used the IMS Health Xponent database to analyze oral antibiotic prescriptions during 2011. Overall, outpatient antibiotic prescribing rates were high, with 789 prescriptions per 1000 adults and 889 prescriptions per 1000 children.

Azithromycin and amoxicillin were the most commonly prescribed antibiotics among adults and children, respectively. Primary care providers prescribed the most courses of antibiotics, followed by dentists. Prescribing rates overall were highest in the South census region. On multivariable analysis, counties with high rates of obesity, infants and children aged 2 years or younger, women, and prescribers per capita, were more likely to have high antibiotic prescribing rates.


The major strength of this study was the use of a large proprietary database that used pharmaceutical sales data to project all prescription activity and was specific to the patient and provider level. Thus, the results serve as a highly comprehensive overview of outpatient prescribing in the United States as well as an important baseline for future studies investigating changes in outpatient prescribing. A major limitation is that despite high rates of antibiotic prescriptions, because of the lack of data on patient visits and diagnoses, it is unknown what proportion of this prescribing was inappropriate. Nevertheless, this study highlights significant regional and provider variation in prescribing patterns and serves as a strong reminder that antibiotic stewardship across all settings is critical.



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