Outpatient Antibiotic Prescription Trends in the United States: A National Cohort Study

Durkin, Michael J.; Jafarzadeh, S. Reza; Hsueh, Kevin; Sallah, Ya Haddy; Munshi, Kiraat D.; Henderson, Rochelle; Fraser, Victoria J.

doi:10.1017/ice.2018.26

Cited by 114 publications

(97 citation statements)

References 35 publications

(63 reference statements)

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“…Ampicillin and Amoxicillin, on the other hand, were only detected in CWW. These findings are consistent with previous reports, that β-lactam antibiotics are largely used inside and outside hospitals with Amoxicillin being one of the most frequently used antibiotics for outpatient prescription (Durkin et al, 2018;Hicks et al, 2015; European Centre For Disease Prevention And Control, 2018). Quinolones and sulfonamides are more frequently used in hospitals than for outbound patients in the Netherlands (European Centre For Disease Prevention And Control, 2018).…”

Section: Resultssupporting

confidence: 93%

The impact of on-site hospital wastewater treatment on the downstream communal wastewater system in terms of antibiotics and antibiotic resistance genes

Paulus

Hornstra

Alygizakis

et al. 2019

International Journal of Hygiene and Environmental Health

148

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This study quantified antibiotic and antibiotic resistance gene (ARG) concentrations in hospital and communal wastewaters as well as the influents and effluents of the receiving urban wastewater treatment plants (UWWTP) in two Dutch cities. In only one city, hospital wastewater was treated on-site using advanced technologies, including membrane bioreactor treatment (MBR), ozonation, granulated activated carbon (GAC) and UVtreatment. On-site hospital wastewater (HWW) treatment reduced gene presence of hospital-related antibiotic resistance genes and antibiotic concentrations in the receiving urban wastewater treatment plant. These findings support the need for on-site treatment of high-risk point sources of antibiotic resistance genes. 13 antibiotic resistance genes, Integrase Class 1 and 16S rRNA concentrations were quantified using multiplex quantitative real-time PCR (qPCR) assays and the presence and/or concentration of 711 antibiotics were analyzed. Hospital wastewater contained approximately 25% more antibiotics and gene concentrations between 0.4 log to 1.8-fold higher than communal wastewater (CWW). bla KPC and vanA could be identified as hospital-related genes and were reduced to under the limit of detection (LOD) during on-site treatment. Advanced on-site treatment removed between 0.5 and 3.6-fold more genes than conventional biological urban wastewater treatment (activated sludge). Advanced on-site treatment was able to eliminate 12 out of 19 detected antibiotics, while urban waste water treatment eliminated up to 1 (out of 21 detected). Different advanced treatment technologies were able to target different pollutants to varying extents, making sequential alignment more effective. MBR treatment was most efficient in antibiotic resistance gene reduction and ozonation in antibiotic reduction. bla KPC could only be detected in the influent of the urban wastewater treatment plant receiving untreated hospital wastewater. Similarly, vanA was only consistently detected in this treatment plant. These results indicate a positive effect of on-site treatment of hospital wastewater on the communal sewage system.

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Section: Resultssupporting

confidence: 93%

The impact of on-site hospital wastewater treatment on the downstream communal wastewater system in terms of antibiotics and antibiotic resistance genes

Paulus

Hornstra

Alygizakis

et al. 2019

International Journal of Hygiene and Environmental Health

148

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“…When looking at the pattern of antibiotic consumption, we found that cephalosporin was the most consumed antibiotics in China's hospitals, followed by combinations of penicillins, which were often defined as extended-spectrum antibiotics, and quinolones. This pattern was similar to the previous studies conducted in other regions of China [19,20],as well as national surveillance data [18], whilst more penicillins were prescribed in Europe and United States [28][29][30].This might partly attribute to the different setting that antibiotics were consumed with more consumption was made to inpatient setting in China, whereas ambulatory care setting consumed more antibiotics as mentioned.…”

Section: Discussionsupporting

confidence: 90%

Secular trend analysis of antibiotic consumption in China’s hospitals 2011-2018, a retrospective analysis of sales data

Wushouer

Zhou

Zhang

et al. 2019

Preprint

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Background: This study was aimed to explore the secular trends of antibiotic consumption over an 8-year period. Methods: We retrospectively analysed aggregated monthly surveillance data on antibiotic sales to 586 hospitals from 28 provinces in China from January 2011 to December 2018. Information including generic name, sales amount, dosage form, strength, the route of administration, and geographical data were collected. Population weighted Antibiotic consumption was expressed in DDD per 1,000 inhabitants per day (DID). WHO’s ‘Access, Watch, Reserve’ categorization was also adopted to analyse antibiotic consumption. Results: Between 2011 and 2018, total antibiotic consumption in China’s hospitals increased by 38.2% (from 4.8 DID in 2010 to 6.7 DID in 2018). Antibiotic consumption was stable or had moderately decreased in 13 provinces, while the other 15 provinces had substantially increased. Cephalosporins were the most consumed antibiotics, accounted for 26.9% of the total antibiotic consumption. In 2018, antibiotics in the Access category comprised 20.0% of total consumption, where antibiotics in the Watch category consumed the most with 72.2%. Population-weighted antibiotic consumption was larger in secondary hospitals than tertiary hospitals (7.3 DID VS 6.6 DID). The antibiotics consumption of oral form was almost two times the consumption of parenteral forms in secondary hospitals, whereas the proportion of tertiary hospitals was about the same. Conclusions: Although efforts were made towards restricting antibiotics in the past decade by Chinese government, antibiotic consumption demonstrated an upward trend during the study period. More efforts are needed to explore the quality of antibiotic usage in terms of rationality.

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“…A national analysis of outpatient antibiotic prescribing trends in the United States between 2006 and 2010 demonstrated a very slight reduction in antibiotic use [30]. More recent data from Express Scripts Holding Company, the largest pharmacy benefits manager in the United States, did not identify substantial reductions in outpatient antibiotic prescribing practices between 2013 and 2015 [31]. …”

Section: Discussionmentioning

confidence: 99%

An Assessment of Inappropriate Antibiotic Use and Guideline Adherence for Uncomplicated Urinary Tract Infections

Durkin¹,

Keller²,

Butler

et al. 2018

Open Forum Infectious Diseases

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BackgroundIn 2011, The Infectious Diseases Society of America released a clinical practice guideline (CPG) that recommended short-course antibiotic therapy and avoidance of fluoroquinolones for uncomplicated urinary tract infections (UTIs). Recommendations from this CPG were rapidly disseminated to clinicians via review articles, UpToDate, and the Centers for Disease Control and Prevention website; however, it is unclear if this CPG had an impact on national antibiotic prescribing practices.MethodsWe performed a retrospective cohort study of outpatient and emergency department visits within a commercial insurance database between January 1, 2009, and December 31, 2013. We included nonpregnant women aged 18–44 years who had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code for a UTI with a concurrent antibiotic prescription. We performed interrupted time series analyses to determine the impact of the CPG on the appropriateness of the antibiotic agent and duration.ResultsWe identified 654 432 women diagnosed with UTI. The patient population was young (mean age, 31 years) and had few comorbidities. Fluoroquinolones, nonfirstline agents, were the most commonly prescribed antibiotic class both before and after release of the guidelines (45% vs 42%). Wide variation was observed in the duration of treatment, with >75% of prescriptions written for nonrecommended treatment durations. The CPG had minimal impact on antibiotic prescribing behavior by providers.ConclusionsInappropriate antibiotic prescribing is common for the treatment of UTIs. The CPG was not associated with a clinically meaningful change in national antibiotic prescribing practices for UTIs. Further interventions are necessary to improve outpatient antibiotic prescribing for UTIs.

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Outpatient Antibiotic Prescription Trends in the United States: A National Cohort Study

Cited by 114 publications

References 35 publications

The impact of on-site hospital wastewater treatment on the downstream communal wastewater system in terms of antibiotics and antibiotic resistance genes

The impact of on-site hospital wastewater treatment on the downstream communal wastewater system in terms of antibiotics and antibiotic resistance genes

Secular trend analysis of antibiotic consumption in China’s hospitals 2011-2018, a retrospective analysis of sales data

An Assessment of Inappropriate Antibiotic Use and Guideline Adherence for Uncomplicated Urinary Tract Infections

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