Comment in:
Summary for patients in:
Changing use of antibiotics in community-based outpatient
practice, 1991-1999.
Steinman MA, Gonzales R, Linder JA, Landefeld CS.
Division of Geriatrics, San Francisco Veterans Affairs Medical Center and
University of California, San Francisco 94121, USA. mstein@itsa.ucsf.edu
BACKGROUND: Judicious use of antibiotics can slow the spread of antimicrobial
resistance. However, overall patterns of antibiotic use among ambulatory
patients are not well understood. OBJECTIVE: To study patterns of outpatient
antibiotic use in the United States, focusing on broad-spectrum antibiotics.
DESIGN: Cross-sectional survey in three 2-year periods (1991-1992, 1994-1995,
and 1998-1999). SETTING: The National Ambulatory Medical Care Survey, a
nationally representative sample of community-based outpatient visits. PATIENTS:
Patients visiting community-based outpatient clinics. MEASUREMENTS: Rates of
overall antibiotic use and use of broad-spectrum antibiotics (azithromycin and
clarithromycin, quinolones, amoxicillin-clavulanate, and second- and
third-generation cephalosporins). All comparisons were made between the first
study period (1991-1992) and the final study period (1998-1999). RESULTS:
Between 1991-1992 and 1998-1999, antibiotics were used less frequently to treat
acute respiratory tract infections, such as the common cold and pharyngitis.
However, use of broad-spectrum agents increased from 24% to 48% of antibiotic
prescriptions in adults (P < 0.001) and from 23% to 40% in children (P < 0.001).
Use of broad-spectrum antibiotics increased across many conditions, increasing
two- to threefold as a percentage of total antibiotic use for a variety of
diagnoses in both adults and children. By 1998-1999, 22% of adult and 14% of
pediatric prescriptions for broad-spectrum antibiotics were for the common cold,
unspecified upper respiratory tract infections, and acute bronchitis, conditions
that are primarily viral. CONCLUSIONS: Antibiotic use in ambulatory patients is
decreasing in the United States. However, physicians are increasingly turning to
expensive, broad-spectrum agents, even when there is little clinical rationale
for their use.
PMID: 12667022 [PubMed - indexed for MEDLINE]