Outpatient Antibiotic Prescriptions — United States, 2017

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Citation: Centers for Disease Control and Prevention. Outpatient antibiotic prescriptions — United States, 2017.

Data Sources:

Systemic oral antibiotics were extracted from the IQVIA Xponent database. IQVIA captured an estimated 90% of retail outpatient prescriptions for any medication nationally, reconciled them to wholesale deliveries to these pharmacies, and projected to 100% coverage. These data represent all outpatient antibiotic prescriptions from community pharmacies from all payers, but exclude federal facilities. Provider specialties are taken from the American Medical Association (AMA) self-designated practice specialties, DEA and NPI sources and categorized into one of 17 groups. Population data were obtained from the U.S. Census bridging files. Starting in 2017, enhancements to IQVIA’s methodology also take into account that some prescriptions which are ordered may not be picked up by the patient and that patients may not pay for their prescriptions in the way that the pharmacy expects, leading to prescriptions that are ultimately not dispensed. Previous methodology did not account for the return or restocking of these prescriptions filled, but not picked up by patients. Accounting for these situations, which can lead to overstated prescriptions, likely makes the revised methodology data more accurate. However, for comparisons to previous years of estimates the previous methodology data should be used.

Total outpatient oral antibiotic prescriptions in 2017

 

Previous methodology: 267.6 million total oral antibiotic prescriptions, equivalent to 821 prescriptions per 1000 persons

Revised methodology: 258.2 million total antibiotic prescriptions, equivalent to 793 prescriptions per 1000 persons

Table 1. Oral antibiotic prescriptions by age, sex and region—United States, 2017

Age groupc

For each age group, number of prescriptions and rate per 1,000
Characteristics NUMBER OF ANTIBIOTIC PRESCRIPTIONS (MILLIONS) ANTIBIOTIC PRESCRIPTIONS PER 1,000 PERSONS, RATE NUMBER OF ANTIBIOTIC PRESCRIPTIONS (MILLIONS) ANTIBIOTIC PRESCRIPTIONS PER 1,000 PERSONS, RATE
Previous methodologya Revised methodologyb
<20 years 62.5 760 60.4 735
≥20 years 205.1 842 197.7 812

Sexc

For each sex, number of prescriptions and rate per 1,000
Characteristics NUMBER OF ANTIBIOTIC PRESCRIPTIONS (MILLIONS) ANTIBIOTIC PRESCRIPTIONS PER 1,000 PERSONS, RATE NUMBER OF ANTIBIOTIC PRESCRIPTIONS (MILLIONS) ANTIBIOTIC PRESCRIPTIONS PER 1,000 PERSONS, RATE
Previous methodologya Revised methodologyb
Female 163.0 986 157.1 950
Male 104.5 651 100.9 629

Regiond

For each region, number of prescriptions and rate per 1,000
2characteristics NUMBER OF ANTIBIOTIC PRESCRIPTIONS (MILLIONS) ANTIBIOTIC PRESCRIPTIONS PER 1,000 PERSONS, RATE NUMBER OF ANTIBIOTIC PRESCRIPTIONS (MILLIONS) ANTIBIOTIC PRESCRIPTIONS PER 1,000 PERSONS, RATE
Previous methodologya Revised methodologyb
Midwest 58.7 861 56.7 831
Northeast 48.5 859 46.9 831
South 114.1 923 110.0 890
West 46.3 598 44.6 576

aEstimates created using previous IQVIA methodology
bEstimates created using data from revised methodology accounting for reversed and voided prescriptions across weeks
cTotals may not add to all oral prescriptions due to missing data
dTotals may not add to all oral prescriptions due to rounding

Table 2. Top oral antibiotic classes and agents prescribed—United States, 2017

Antibiotic class

For each antibiotic class, number of prescriptions and rate per 1,000
Characteristics NUMBER OF ANTIBIOTIC PRESCRIPTIONS (MILLIONS) ANTIBIOTIC PRESCRIPTIONS PER 1,000 PERSONS, RATE NUMBER OF ANTIBIOTIC PRESCRIPTIONS (MILLIONS) ANTIBIOTIC PRESCRIPTIONS PER 1,000 PERSONS, RATE
Previous methodologya Revised methodologyb
Penicillins 63.1 194 61.3 188
Macrolides 46.1 142 44.6 137
Cephalosporins 37.3 115 36.1 111
Fluoroquinolones 27.5 84 26.7 82
Beta-lactams, increased activity 25.4 78 24.6 76

Antibiotic agent

For each antibiotic agent, number of prescriptions and rate per 1,000
Characteristics NUMBER OF ANTIBIOTIC PRESCRIPTIONS (MILLIONS) ANTIBIOTIC PRESCRIPTIONS PER 1,000 PERSONS, RATE NUMBER OF ANTIBIOTIC PRESCRIPTIONS (MILLIONS) ANTIBIOTIC PRESCRIPTIONS PER 1,000 PERSONS, RATE
Previous methodologya Revised methodologyb
Amoxicillin 57.0 175 55.5 170
Azithromycin 43.6 134 42.2 130
Amoxicillin/clavulanic acid 27.5 84 26.7 82
Cephalexin 22.1 68 21.3 65
Sulfamethoxazole/trimethoprim 19.4 60 18.7 57

a. Estimates created using previous IQVIA methodology
b. Estimates created using data from revised methodology accounting for reversed and voided prescriptions across weeks


Table 3. Oral antibiotic prescriptions by provider specialty — United States, 2017

For each provider specialty, number of prescriptions and rate per provider
Characteristics NUMBER OF ANTIBIOTIC PRESCRIPTIONS (MILLIONS) ANTIBIOTIC PRESCRIPTIONS PER PROVIDERS, RATE NUMBER OF ANTIBIOTIC PRESCRIPTIONS (MILLIONS) ANTIBIOTIC PRESCRIPTIONS PER PROVIDERS, RATE
Previous methodologya Revised methodologyb
Primary Care Physicians 100.8 425 97.4 410
Physician Assistants and Nurse Practitioners 73.5 424 70.9 409
Surgical Specialties 18.7 210 18.1 202
Dentistry 25.6 209 24.9 203
Emergency Medicine 14.1 436 13.6 421
Dermatology 6.5 572 6.1 536
Obstetrics/Gynecology 5.7 152 5.4 144
Other 22.7 109 21.8 105
All Providers 267.6 293 258.2 283

a. Estimates created using previous IQVIA methodology
b. Estimates created using data from revised methodology accounting for reversed and voided prescriptions across weeks


Figure 1. Antibiotic prescriptions per 1000 persons by state (sextiles) for all ages — United States, 2017.

Outpatient Antibiotic Prescriptions by State in 2017

This project was made possible through a partnership with the CDC Foundation. Support for this project was provided by The Pew Charitable Trusts.

Antibiotic prescriptions per 1000 persons by state (sextiles) for all ages — United States, 2016.
State Antibiotic prescriptions per 1000 persons, Rate
Previous methodologya Revised methodologyb
West Virginia 1254 1215
Kentucky 1239 1199
Mississippi 1222 1182
Louisiana 1204 1159
Alabama 1178 1137
Tennessee 1142 1098
Arkansas 1107 1069
Nebraska 986 954
Iowa 946 918
Ohio 945 914
Indiana 933 899
Kansas 931 898
South Carolina 929 898
District of Columbia 910 877
New York 901 869
Oklahoma 899 869
New Jersey 891 862
Missouri 890 861
Delaware 885 857
Michigan 885 856
Pennsylvania 883 852
Rhode Island 879 849
Georgia 872 841
South Dakota 862 841
Texas 852 820
North Carolina 844 816
Connecticut 839 809
Florida 831 799
Illinois 822 791
Virginia 784 758
Wyoming 770 746
North Dakota 768 742
Maryland 764 738
Massachusetts 748 721
Arizona 735 703
Utah 725 700
New Hampshire 724 700
Nevada 711 683
Wisconsin 703 678
Maine 698 677
New Mexico 681 655
Idaho 674 652
Minnesota 658 636
Vermont 645 628
Montana 618 599
Hawaii 617 597
California 565 544
Colorado 565 544
Washington 560 541
Oregon 520 502
Alaska 504 489

a. Estimates created using previous IQVIA methodology
b. Estimates created using data from revised methodology accounting for reversed and voided prescriptions across weeks