Antimicrobial drug prescription in ambulatory care settings, United States, 1992-2000

Abstract

During the 1990s, as antimicrobial resistance increased among pneumococci, many organizations promoted appropriate antimicrobial use to combat resistance. We analyzed data from the National Ambulatory Medical Care Survey, an annual sample survey of visits to office-based physicians, and the National Hospital Ambulatory Medical Care Survey, an annual sample survey of visits to hospital emergency and outpatient departments, to describe trends in antimicrobial prescribing from 1992 to 2000 in the United States. Approximately 1,100-1,900 physicians reported data from 21,000-37,000 visits; 200-300 outpatient departments reported data for 28,000-35,000 visits; approximately 400 emergency departments reported data for 21,000-36,000 visits each year. In that period, the population- and visit-based antimicrobial prescribing rates in ambulatory care settings decreased by 23% and 25%, respectively, driven largely by a decrease in prescribing by office-based physicians. Antimicrobial prescribing rates changed as follows: amoxicillin and ampicillin, -43%; cephalosporins, -28%; erythromycin, -76%; azithromycin and clarithromycin, +388%; quinolones, +78%; and amoxicillin/clavulanate, +69%. This increasing use of azithromycin, clarithromycin, and quinolones warrants concern as macrolide- and fluoroquinolone-resistant pneumococci are increasing.

Figure 1

Trends in annual antimicrobial prescribing rates—United States, 1992–2000. Note: all trends shown are significant (p<0.001).

Figure 2

Trends in annual antimicrobial prescribing rates by age—United States, 1992–2000. Note: trend for visits by patients <15 years of age, p<0.001; for visits by patients 15–24 years, p=0.007; for visits by patients 25–44 years, p<0.001.

Figure 3

Trends in annual antimicrobial prescribing rates for persons <15 years of age by setting—United States, 1992–2000. Note: trend for office setting and emergency departments, p<0.001.

Figure 4

Trends in annual antimicrobial prescribing rates for persons >15 years of age by setting—United States, 1992–2000. Note: trend for office setting, p<0.001; trend for outpatient departments, p=0.002.

Figure 5

Trends in decreasing annual antimicrobial prescribing rates by drug class—United States, 1992–2000. Note: all trends shown are significant (p<0.001).

Figure 6

Trends in increasing annual antimicrobial prescribing rates by drug class—United States, 1992–2000. Note: trend for amoxicillin/clavulanate prescribing among children<15 years of age, p=0.004; for quinolones among persons >15 years, p<0.001; for azithromycin and clarithromycin among all ages, p<0.001.