At a glance
- CDC monitors antibiotic use in outpatient, acute, and long-term care settings.
- Antibiotics are commonly prescribed unnecessarily in different healthcare settings.
- Measuring and evaluating antibiotic use across healthcare settings helps ensure that antibiotics are prescribed appropriately.
Overview
- The National Action Plan for Combating Antibiotic Resistant Bacteria (CARB) is a coordinated, strategic plan to address antimicrobial resistance that guides CDC's antimicrobial resistance investments and activities. CARB includes national goals to improve antibiotic use.
- CDC uses different surveillance systems, data sources, and metrics to measure and report antibiotic use in outpatient, acute care, and long-term care settings.
- Antibiotic use surveillance data can be used by healthcare facilities to prioritize antibiotic stewardship strategies.
Outpatient settings
Prescribing trends
- Most human antibiotic use (85-95%) occurs in outpatient settings. 1
- At least 28% of antibiotics prescribed in outpatient settings are considered unnecessary.2
- There are also opportunities to improve selection, dosing, and duration of antibiotics prescribed.
Antibiotic use surveillance data sources
- Outpatient pharmacy dispensing data are used to track the number and rates of oral antibiotics dispensed in U.S. community pharmacies.3
- Outpatient administrative claims data are submitted by healthcare organizations to receive reimbursement from health payers for services provided and can be used to assess appropriateness of antibiotics prescribed for specific diagnoses4.
- Healthcare Effectiveness Data and Information Set (HEDIS) measures examine the quality of antibiotic prescribing by region and across health plans. These data are reported by healthcare insurance organizations and can be used to improve antibiotic prescribing. There are four HEDIS measures related to antibiotic use: 1) Utilization for respiratory conditions, 2) Avoidance of antibiotic treatment for bronchitis, 3) Treatment for upper respiratory infections, and 4) Appropriate testing for pharyngitis
- Electronic health record data capture details of patient encounters and can be used for antibiotic use surveillance.5
Antibiotic prescribing reports
Outpatient pharmacy dispensing data provide outpatient antibiotic prescription volumes by year, age, sex, state, antibiotic class, and provider specialty. View outpatient antibiotic prescription data on CDC's Antimicrobial Resistance & Patient Safety Portal.
- 2024 Outpatient Antibiotic Prescribing Report
- 2023 Outpatient Antibiotic Prescribing Report
- 2022 Outpatient Antibiotic Prescribing Report
- 2021 Outpatient Antibiotic Prescribing Report
- 2020 Outpatient Antibiotic Prescribing Report
- 2019 Outpatient Antibiotic Prescribing Report
- 2018 Outpatient Antibiotic Prescribing Report
- 2017 Outpatient Antibiotic Prescribing Report
- 2016 Outpatient Antibiotic Prescribing Report
- 2015 Outpatient Antibiotic Prescribing Report
- 2014 Outpatient Antibiotic Prescribing Report
- 2013 Outpatient Antibiotic Prescribing Report
- 2012 Outpatient Antibiotic Prescribing Report
- 2011 Outpatient Antibiotic Prescribing Report
Acute care hospitals
Prescribing trends
About 30% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or suboptimal.6
Antibiotic use surveillance data sources
- The National Healthcare Safety Network (NHSN) Antimicrobial Use and Resistance (AUR) Module provides a mechanism for hospitals to report and analyze antimicrobial use data to inform benchmarking antimicrobial stewardship efforts.
- Hospital healthcare-associated infection and antimicrobial use prevalence surveys gather data on patients admitted to hospitals to identify trends and improve patient safety7.
- Electronic health records capture antibiotic orders and administration and can be used to assess antibiotic prescribing and appropriateness.8
Long-term care settings
Prescribing trends
Approximately 50% of long-term care facility residents will be prescribed an antibiotic annually.910
Antibiotic use surveillance data sources
- Long-term care pharmacies contract specialized services to long-term care facilities, including dispensing and delivery of medications. Pharmacy transactions can be used to report antibiotic use at the facility level.9
- Electronic health record data capture medication orders or administration and can be used to assess antibiotic use and inform stewardship efforts.10
- Nursing home surveys gather data on healthcare-associated infection and antibiotic use among residents in long-term care facilities.11
Terms to know
Appropriate antibiotic prescribing
- Antibiotics are prescribed when needed: the right antibiotic is selected at the right dose and for the right duration.
- Antibiotics are prescribed in accordance with national and local guidelines and recommendations.
Inappropriate antibiotic prescribing
Inappropriate prescribing includes:
- Unnecessary use of antibiotics for diagnoses that do not require an antibiotic (e.g., bronchitis) or duplicate treatment (e.g., dual anaerobic coverage).
- Suboptimal antibiotic selection, dose, or treatment duration.
Antibiotic use metrics and quality measures12
- Antibiotic use metrics can assess antibiotic use by reporting the volume or appropriateness of prescriptions.
- An antibiotic use quality measure is a standardized method for assessing appropriateness of antibiotic use and can be used to compare performance across health plans, facilities, or healthcare professionals to ensure that antibiotics are prescribed appropriately.
- Duffy E, Ritchie S, Metcalfe S, Van Bakel B, Thomas MG. Antibacterials dispensed in the community comprise 85%-95% of total human antibacterial consumption. J Clin Pharm Ther. 2018 Feb;43(1):59-64.
- Hersh AL, King LM, Shapiro DJ, Hicks LA, Fleming-Dutra KE. Unnecessary Antibiotic Prescribing in US Ambulatory Care Settings, 2010-2015. Clin Infect Dis. 2021;72(1):133-137.
- Outpatient Antibiotic Use: Retail Pharmacy Prescription Data | A.R. & Patient Safety Portal
- King LM, Tsay SV, Hicks LA, Bizune D, Hersh AL, Fleming-Dutra K. Changes in outpatient antibiotic prescribing for acute respiratory illnesses, 2011 to 2018. Antimicrob Steward Healthc Epidemiol. 2021 Dec 17;1(1):1-8.
- McIsaac WJ, Kukan S. Assessing the Validity of Electronic Medical Records for Identifying High Antibiotic Prescribers in Primary Care. J Prim Care Community Health. 2023 Jan-Dec;14:21501319231210616.
- Fridkin S, Baggs J, Fagan R, et al. Vital signs: improving antibiotic use among hospitalized patients. MMWR Morb Mortal Wkly Rep. Mar 7 2014;63(9):194-200.
- Magill SS, O'Leary E, Ray SM, et al. Antimicrobial Use in US Hospitals: Comparison of Results From Emerging Infections Program Prevalence Surveys, 2015 and 2011.Clin Infect Dis. 2021;72(10):1784-1792.
- Rose AN, Baggs J, Wolford H, Neuhauser MM, Srinivasan A, Gundlapalli AV, Reddy S, Kompaniyets L, Pennington AF, Grigg C, Kabbani S. Trends in Antibiotic Use in United States Hospitals During the Coronavirus Disease 2019 Pandemic. Open Forum Infect Dis. 2021 Jun 3;8(6):ofab236.
- Gouin KA, Creasy S, Beckerson M, Wdowicki M, Hicks LA, Kabbani S. Description of national antibiotic prescribing rates in U.S. long-term care facilities, 2013-2021. Antimicrob Steward Healthc Epidemiol. 2024;4(1):e209. Published 2024 Nov 21.
- Kabbani S, Wang SW, Ditz LL, et al. Description of antibiotic use variability among US nursing homes using electronic health record data. Antimicrob Steward Healthc Epidemiol. 2021;1(1):e58. Published 2021 Dec 7
- Thompson ND, Stone ND, Brown CJ, et al. Antimicrobial use in a cohort of US nursing homes, 2017. JAMA 2021;325:1286–1295.
- CHCS. Center for Health Care Strategies (2020). https://www.chcs.org/media/Improving-Antibiotic-Use-Measurement-071320.pdf
- Arena CJ, Veve MP, Fried ST, Ware F, Lee P, Shallal AB. Navigating performance measures for ambulatory antimicrobial stewardship: a review of HEDIS® and other metrics the steward should know. Antimicrob Steward Healthc Epidemiol. 2024 Dec 13;4(1):e217.