About one-third of outpatient antibiotic prescriptions may be inappropriate, according to a new study. CDC researchers used a national database of ambulatory visits in which oral antibiotics were prescribed for a number of outpatient conditions. Of the 184,000 visits, 12.6% received an antibiotic with the most common diagnosis of sinusitis, followed by otitis media and pharyngitis. Per thousand population, 506 antibiotic prescriptions were written, of which 353 were considered to be appropriate (pneumonia and urinary tract infections) and 149 were deemed inappropriate (acute bronchitis). Sinusitis and pharyngitis were considered indications for which antibiotics may be indicated. The authors concluded that these findings support the need for establishing outpatient antibiotic stewardship programs (JAMA 2016;315:1864-1873).
An accompanying editorial suggests that the number of inappropriate antibiotics may be underestimated because the authors did not count other encounters, such as telephone calls or practice sites such as urgent care clinics, retail pharmacies, and dentist offices, where antibiotics are frequently prescribed. Nonetheless, this new study “addresses an important area of uncertainty,” and provides useful information for the White House National Action Plan for Combating Antibiotic-Resistant Bacteria, which calls for a reduction in inappropriate outpatient antibiotics by 50% by 2020 (JAMA 2016;315:1839-1841).