Outpatient Antibiotic Prescriptions — United States, 2018

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Citation: Centers for Disease Control and Prevention. Outpatient antibiotic prescriptions — United States, 2018.

Data Sources:

Systemic oral antibiotics were extracted from the IQVIA Xponent database. IQVIA captured an estimated 92% 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 2018

 

Previous methodology: 258.9 million total oral antibiotic prescriptions, equivalent to 791 prescriptions per 1000 persons

Revised methodology: 249.8 million total antibiotic prescriptions, equivalent to 763 prescriptions per 1000 persons

Table 1. Oral antibiotic prescriptions by age, sex and region—United States, 2018

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 58.2 710 56.2 686
≥20 years 200.7 818 193.2 788

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 157.9 951 152.1 916
Male 100.9 626 97.4 604

Regiond

For each region, 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
Midwest 55.8 817 53.8 788
Northeast 47.1 839 45.3 808
South 111.6 895 107.7 863
West 44.4 569 42.9 550

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, 2018

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 60.6 185 59 180
Macrolides 41.9 128 40.5 124
Cephalosporins 37.2 114 35.9 110
Beta-lactams,  Increased activity 27.5 84 26.6 81
Tetracyclines 24.3 74 23 70

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 55.3 169 53.8 164
Azithromycin 39.7 121 38.5 118
Amoxicillin/clavulanic acid 27.5 84 26.6 81
Cephalexin 22.2 68 21.4 65
Doxycycline 20.2 62 19.2 59

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, 2018

For each provider specialty, number of prescriptions and rate per provider

For each provider specialty, number of prescriptions and rate per provider
Provider Specialty 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
Primary Care Physicians 92.5 389 89.3 376
Physician Assistants and Nurse Practitioners 76.5 442 73.3 423
Surgical Specialties 18.2 204 17.5 196
Dentistry 25.4 207 24.7 201
Emergency Medicine 13.1 404 12.7 392
Dermatology 6.3 555 5.9 525
Obstetrics/Gynecology 5.4 145 5.1 137
Other 21.5 103 21.2 102
All Providers 258.9 284 249.8 274

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 1,000 persons by state (sextiles) for all ages— United States, 2018, estimates created using previous IQVIA methodology

Outpatient Antibiotic Prescriptions by State in 2018 (previous methodology)

Figure 2. Antibiotic prescriptions per 1,000 persons by state (sextiles) for all ages— United States, 2018, estimates created using revised methodology accounting for reversed and voided prescriptions across weeks

Outpatient Antibiotic Prescriptions by State in 2018 (revised methodology)

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 1,000 persons, Rate
Previous methodologya Revised methodologyb
West Virginia 1197 1185
Kentucky 1174 1127
Mississippi 1170 1117
Louisiana 1169 1122
Alabama 1158 1116
Tennessee 1184 1037
Arkansas 1051 1011
Nebraska 973 935
Iowa 902 873
Ohio 901 869
Indiana 875 844
Kansas 904 874
South Carolina 900 868
District of Columbia 872 830
New York 891 857
Oklahoma 888 849
New Jersey 874 844
Missouri 835 806
Delaware 853 805
Michigan 841 814
Pennsylvania 841 811
Rhode Island 859 824
Georgia 861 834
South Dakota 830 811
Texas 831 803
North Carolina 799 775
Connecticut 825 789
Florida 823 798
Illinois 785 750
Virginia 745 718
Wyoming 778 753
North Dakota 712 688
Maryland 746 718
Massachusetts 725 696
Arizona 697 669
Utah 686 665
New Hampshire 694 678
Nevada 682 653
Wisconsin 656 632
Maine 673 650
New Mexico 672 637
Idaho 648 634
Minnesota 621 602
Vermont 606 588
Montana 593 584
Hawaii 598 577
California 537 518
Colorado 531 515
Washington 531 519
Oregon 495 490
Alaska 462 451

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