Antibiotic Prescribing and Use in the U.S.

Antibiotic Use in the United States, 2017: Progress and Opportunities

Executive Summary

The Centers for Disease Control and Prevention (CDC) focuses on helping healthcare providers deliver the best possible care for patients every day. Research shows that one way we can improve patient care is through better use of antibiotics.

Modern medicine depends on antibiotics to protect people against infection. These powerful drugs have transformed health care, but as with any medicine, antibiotics carry risks. When antibiotics are needed, the benefits usually outweigh the risks. However, when a patient takes an antibiotic when it is not needed, the patient gets no benefit and is unnecessarily exposed to preventable, and potentially serious, health problems. Each time an antibiotic is used, it can increase the risk that a future infection will be resistant to antibiotics.

Antibiotic resistance occurs when bacteria do not respond to the drugs designed to kill them. It is one of the most serious public health problems in the United States and threatens to return us to the time when simple infections were often fatal. Improving the way we prescribe and use antibiotics, a concept referred to as “antibiotic stewardship,” is critical for all healthcare settings. When we optimize the treatment of infections, we protect patients from harm and combat antibiotic resistance.

Antibiotic Use in Healthcare Settings: Current Status

The United States has made progress in understanding antibiotic prescribing and use in health care and in the community. But there are many opportunities to improve.

Outpatient Settings: Nationally, antibiotic prescribing in outpatient settings like clinics, doctor’s offices, and emergency rooms decreased by five percent from 2011 to 2014, but variations among age groups and geographic locations point to areas where prescribing can be improved. CDC estimates that 30 percent of all antibiotics prescribed in outpatient clinics are unnecessary. Even when antibiotics are needed, prescribers often favor drugs that may be less effective and carry more risk over more targeted first-line drugs recommended by national guidelines.

Nursing Homes: More data are needed to understand antibiotic use in nursing homes, where approximately four million Americans receive care each year. A small CDC study of nine nursing homes showed that 11 percent of nursing home residents were taking antibiotics on any single day, and nearly 40 percent of orders for antibiotics lacked important prescribing information. CDC is launching a larger study with more nursing homes across the country and pursuing partnerships with nursing home networks, pharmacies, and other companies to identify where action is needed most.

Hospitals: Hospital antibiotic use data point to opportunities to improve prescribing practices. For example, use of the most powerful antibiotics increased significantly from 2006 to 2012, by nearly 40 percent for carbapenems and more than 30 percent for vancomycin. Data also indicate that roughly 30 percent of antibiotics used in hospitals are unnecessary or prescribed incorrectly.

Improving Antibiotic Use: CDC’s Role

Improving antibiotic prescribing and use is part of CDC’s Antibiotic Resistance Solutions Initiative, a comprehensive approach to combat antibiotic resistance that includes aggressive responses to outbreaks, groundbreaking approaches to research, and new investments in state and local infection prevention and control. To accelerate improvements and help healthcare facilities and providers make the best decisions to treat and protect their patients, CDC provides technical expertise and tools for implementation, data for action, support for innovation, and education resources.

Evidence and Tools for Implementation: CDC’s Core Elements of Antibiotic Stewardship provide frameworks for antibiotic stewardship programs and practices in outpatient settings, nursing homes, and hospitals, including small hospitals in rural areas. CDC works with public health and healthcare partners including health systems, hospital associations, professional organizations, academic investigators, private industry, patient and consumer organizations, state and local health departments, and federal partners to promote and facilitate implementation of the Core Elements. For example, CDC worked with local, state, and national experts to create the National Quality Partners Playbook: Antibiotic Stewardship in Acute CareExternal, a practical guide to help hospitals and health systems of all sizes implement the Core Elements. When CDC’s National Healthcare Safety Network (NHSN) annual survey data indicated that smaller hospitals were less likely to implement all of the Core Elements, CDC worked with rural health, hospital, and federal partners to tailor the Core Elements to support implementation in small hospitals and address their specific needs.

Measuring Antibiotic Use in Healthcare: Data for Action: One of the most important ways CDC helps improve antibiotic use is producing and analyzing data to support healthcare facilities and providers in making the best choices for their patients. Healthcare facilities can use these data to identify opportunities to ensure appropriate antibiotic use, assess the impact of antibiotic stewardship efforts, and improve patient care. CDC is working with partners in all settings to identify, track, and understand antibiotic use data.

Hospitals participating in CDC’s NHSN Antibiotic Use Option can compare their antibiotic use to others, monitor use over time, and direct hospital antibiotic stewardship programs. CDC continues to work with clinical experts on ways to use these data for improvement. For example, CDC collaborated to develop an assessment tool to help hospitals identify opportunities to improve antibiotic use.

Innovation: CDC is constantly looking for novel ways to improve antibiotic prescribing and use, and including exploring innovations related to treatment and diagnostics. One example is CDC’s partnership with industry to investigate mechanisms to protect and restore the microbiome (the community of naturally occurring bacteria in and on the body) when antibiotics are used. Through the CDC and Food and Drug Administration (FDA) Antibiotic Resistance Isolate Bank, CDC is helping advance the development of diagnostic tests to identify and characterize resistant bacteria and accelerating research and development for new antibiotics.

Education: CDC leads Antibiotic use: Know When Antibiotics Work to educate parents of young children, the general public, and outpatient healthcare providers about antibiotic resistance and optimal antibiotic prescribing and use. This work is being refreshed in 2017. In addition, CDC is undertaking a national educational effort to support healthcare providers’ knowledge about early sepsis recognition and treatment, including starting antibiotics quickly when sepsis is suspected and reassessing therapy within 48 hours when the patient’s culture results are back.

Moving Forward

Everyone plays a critical role in improving antibiotic use and preventing infections across health care: healthcare providers; patients and their families; health systems, hospitals, clinics, and nursing homes; healthcare quality organizations; health insurance companies; healthcare provider professional organizations; and federal, state, and local health agencies. CDC is committed to working with partners, supporting implementation of programs and practices that optimize antibiotic prescribing and use, using data for action, supporting innovation, and educating patients and healthcare providers about the benefits and risks of antibiotics. Working together, we can improve and protect the health and well-being of everyone who receives health care and help ensure that life-saving antibiotics will be available for generations to come.