Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011

Fleming-Dutra, Katherine E.; Hersh, Adam L.; Shapiro, Daniel J.; Bartoces, Monina; Enns, Eva A.; File, Thomas M.; Finkelstein, Jonathan A.; Gerber, Jeffrey S.; Hyun, David Y.; Linder, Jeffrey A.; Lynfield, Ruth; Margolis, David J.; May, Larissa; Merenstein, Daniel; Metlay, Joshua P.; Newland, Jason G.; Piccirillo, Jay F.; Roberts, Rebecca M.; Sánchez, Guillermo; Suda, Katie J.; Thomas, Ann; Woo, Teri Moser; Zetts, Rachel M; Hicks, Lauri A.

doi:10.1001/jama.2016.4151

Cited by 1,381 publications

(1,266 citation statements)

References 25 publications

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“…Overprescription is a significant problem for antibiotics and antiacid medications. One recent study found that almost one-third of all outpatient antibiotic prescriptions could be categorised as inappropriate 61. Additionally, antiacid medications continue to be prescribed at high rates in children less than 1 year old, despite limited evidence to support any clinically significant benefits 62.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic and acid-suppression medications during early childhood are associated with obesity

Stark

Susi

Emerick

et al. 2018

Gut

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ObjectiveGut microbiota alterations are associated with obesity. Early exposure to medications, including acid suppressants and antibiotics, can alter gut biota and may increase the likelihood of developing obesity. We investigated the association of antibiotic, histamine-2 receptor antagonist (H2RA) and proton pump inhibitor (PPI) prescriptions during early childhood with a diagnosis of obesity.DesignWe performed a cohort study of US Department of Defense TRICARE beneficiaries born from October 2006 to September 2013. Exposures were defined as having any dispensed prescription for antibiotic, H2RA or PPI medications in the first 2 years of life. A single event analysis of obesity was performed using Cox proportional hazards regression.Results333 353 children met inclusion criteria, with 241 502 (72.4%) children prescribed an antibiotic, 39 488 (11.8%) an H2RA and 11 089 (3.3%) a PPI. Antibiotic prescriptions were associated with obesity (HR 1.26; 95% CI 1.23 to 1.28). This association persisted regardless of antibiotic class and strengthened with each additional class of antibiotic prescribed. H2RA and PPI prescriptions were also associated with obesity, with a stronger association for each 30-day supply prescribed. The HR increased commensurately with exposure to each additional medication group prescribed.ConclusionsAntibiotics, acid suppressants and the combination of multiple medications in the first 2 years of life are associated with a diagnosis of childhood obesity. Microbiota-altering medications administered in early childhood may influence weight gain.

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Section: Discussionmentioning

confidence: 99%

Antibiotic and acid-suppression medications during early childhood are associated with obesity

Stark

Susi

Emerick

et al. 2018

Gut

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“…For example, in the US half of all antibiotic prescriptions are inappropriately written for respiratory illnesses associated with pathogens such as influenza, respiratory syncytial virus (RSV) and other viruses that are not susceptible to antibiotics. 36 These examples illustrate that even viral vaccines can play an important role in reducing antibiotic use that drives bacterial resistance.…”

Section: Impact Of Viral Vaccines On Amrmentioning

confidence: 99%

The role of vaccines in fighting antimicrobial resistance (AMR)

Jansen

Anderson

2018

Human Vaccines & Immunotherapeutics

104

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The problem of antimicrobial resistance (AMR) and the associated morbidity and mortality due to antibiotic resistant bacterial pathogens is not new. However, AMR has been increasing at an alarming rate with appearances of diseases caused by bacteria exhibiting resistance to not just one but multiple classes of antibiotics. The World Health Organization (WHO) supported by governments, health ministries and health agencies has formulated global action plans to combat the rise in AMR, supporting a number of proven initiatives such as antimicrobial stewardship, investments in development of new classes of antibiotics, and educational programs designed to eliminate inappropriate antibiotic use. Vaccines as tools to reduce AMR have historically been under-recognized, yet the positive effect in reducing AMR has been well established. For example Haemophilus influenzae type B (Hib) as well as Streptococcus pneumoniae (pneumococcal) conjugate vaccines have impressive track records in not only preventing life threatening diseases caused by these bacteria, but also reducing antibiotic use and AMR. This paper will describe the drivers of antibiotic use and subsequent development of AMR; it will make the case how existing vaccines are already participating in combatting AMR, describe future prospects for the role of new vaccines in development to reduce AMR, and highlight challenges associated with future vaccine development to combat AMR.

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“…An estimated 30% of outpatient antibiotic prescribing in the United States is unnecessary [1]. Antibiotic prescribing for sinusitis, otitis media, and pharyngitis frequently results in nonrecommended antibiotic prescribing, with macrolides being the most common alternative antibiotic class prescribed [2].…”

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confidence: 99%