Antibiotic Use in the United States, 2017: Progress and Opportunities
Antibiotic Use By Healthcare Setting
What Do We Know About Antibiotic Use in Outpatient Settings?
Outpatient settings include healthcare providers (e.g., physicians, dentists, nurse practitioners, and physician assistants) and clinic leaders in primary care, medical and surgical specialties, emergency departments, retail health and urgent care settings, and dental offices. In 2015 alone, approximately 269 million antibiotic prescriptions were dispensed from outpatient pharmacies in the United States, enough for five out of every six people to receive one antibiotic prescription each year. At least 30 percent of these antibiotic prescriptions were unnecessary.7
On This Page
- Percent of Antibiotic Prescriptions That Were Unnecessary
- Geographic Variability in HEDIS Measures Related to Appropriate Antibiotic Use
- Intended Audiences for Outpatient Antibiotic Stewardship
- Healthcare Providers, Patients, And Families Play A Critical Role In Supporting Optimal Antibiotic Use And Preventing Infections In Outpatient Settings.
Percent of Antibiotic Prescriptions That Were Unnecessary
|Age group||All Conditions*||Acute respiratory conditions**|
|0-19 year olds||29%||34%|
|20-64 year olds||35%||70%|
|≥65 year olds||18%||54%|
*All conditions included acute respiratory conditions, urinary tract infections, miscellaneous bacterial infections, and other conditions.
**Acute respiratory conditions included ear infections, sinus infections, sore throats, pneumonia, acute bronchitis, bronchiolitis, upper respiratory infections (i.e., common colds), influenza, asthma, allergy, and viral pneumonia.
Each year, there are 47 million unnecessary antibiotic prescriptions written in U.S. doctors’ offices and emergency departments.7 Most of these unnecessary prescriptions are for respiratory conditions most commonly caused by viruses (including common colds, viral sore throats, and bronchitis) which do not respond to antibiotics, or for bacterial infections that do not always need antibiotics (like many sinus and ear infections). CDC estimated that at least 50 percent of antibiotic prescriptions for these acute respiratory conditions are unnecessary.8–10 These excess prescriptions each year put patients at needless risk for reactions to drugs or other problems, including C. difficile infections. In 2011 alone, one-third of the nearly 500,000 C. difficile infections in the United States were community-associated, or happening in patients who had no recent overnight stay in a healthcare facility.1–4
The good news is that antibiotic prescribing nationally has improved with a five percent decrease from 2011 to 2014. However, while there have been noticeable declines in antibiotic prescribing in children (0–19) (the population targeted by the Get Smart program) from 75 million prescriptions in 2011 to about 64 million prescriptions in 2014, antibiotic prescription rates for adults have risen slightly from about 192 million in 2011 to 198 million in 2014. Children under two and adults 65 and older still receive the most antibiotic prescriptions. Data also show that antibiotics are prescribed more frequently in states in the Southern and
Prescribing the correct antibiotic is another area that requires attention. A CDC and Pew Charitable Trusts study found among outpatient visits in 2010– 2011, when an antibiotic was needed, patients were often prescribed an antibiotic not recommended by current clinical guidelines. For example, for sinus and middle ear infections and sore throats, recommended first-line antibiotics were only used half (52 percent) of the time.11
Percent of Patients Receiving The Recommended First-Line Antibiotic by Condition, United States, 2010-2011*
(20+ years of age)
(0–19 years of age)
|Pharyngitis (sore throat)||37%||60%|
|Middle ear infection||n/a||67%|
*Based on the prevalence of allergy to first-line antibiotics and estimated treatment failures after first-line antibiotics, at least 80% of patients presenting with these conditions should receive first-line antibiotics. Analysis is based on NAMCS and NHAMCS data.
CDC’s Antibiotic Resistance Patient Safety Atlas contains data on antibiotic prescriptions dispensed in outpatient pharmacies per 1,000 people. This interactive database provides information on how antibiotic prescribing varies by state, age group, and over time from 2011–2014.
Geographic Variability in HEDIS Measures Related to Appropriate Antibiotic Use
Avoidance of antibiotic treatment in adults with acute bronchitis (average), by Census division, 2008–2012
CDC experts found that healthy adults with acute bronchitis only received the right treatment—meaning they did not get an antibiotic—just over 20 percent of the time. This shows that nearly 80 percent of the time, patients were getting an antibiotic unnecessarily.
Over the years there has been little progress made in prescribing for adults, indicating a clear need to better support healthcare providers who prescribe for adults. Family practice physicians prescribe the most antibiotics, but nurse practitioners, physician assistants, internal medicine physicians, pediatricians, and dentists also prescribe antibiotics, making these providers important audiences to reach. Because antibiotics are prescribed more frequently in the Southern and Appalachian regions, there is a need to target antibiotic stewardship efforts to providers and patients in these areas.
Oral Antibiotic Prescribing by Provider Type in the United States In 2014
|Provider type||Number of antibiotic prescriptions in 2014
|Family Practice Physicians||58.1|
|Physician Assistants & Nurse Practitioners||54.4|
Core Elements of Outpatient Antibiotic Stewardship
Demonstrate dedication to and accountability for optimizing antibiotic prescribing and patient safety.
Action for Policy And Practice
Implement at least one policy or practice to improve antibiotic prescribing, assess whether it is working, and modify as needed.
Tracking and Reporting
Monitor antibiotic prescribing practices and offer regular feedback to providers, or have providers assess their own antibiotic prescribing practices themselves.
Education and Expertise
Provide educational resources to providers and patients on antibiotic prescribing, and ensure access to needed expertise on optimizing antibiotic prescribing.
CDC collaborates with partners to implement appropriate antibiotic use efforts at a local level. CDC funds and supports many state and local health departments and other partners across the country to implement targeted antibiotic stewardship improvements in outpatient settings.
Illinois Department of Public Health: Precious Drugs and Scary Bugs
In 2015, the Illinois Department of Public Health (IDPH) developed the Precious Drugs and Scary Bugs program to improve the appropriate use of antibiotics, particularly for acute respiratory infections, in primary care, urgent care, and community health centers. IDPH asked healthcare providers to:
- Display a poster in exam rooms stating their commitment to appropriate antibiotic prescribing.
- Participate in educational webinars.
- Track their antibiotic prescribing data.
- Complete baseline and follow-up surveys.
Thirty-eight outpatient practices participated representing 239 healthcare providers. More than 500 commitment posters were printed and distributed. Participating healthcare providers reported that the poster improved communication, addressed patient expectations regarding antibiotics for acute respiratory infections, and reinforced a uniform message.
New York State Department of Health: Commitments to Appropriate Antibiotic Prescribing
In 2016, the New York State Department of Health (NYSDOH) offered a “Get Smart Guarantee” poster [PDF – 1 page] for healthcare providers to pledge to only prescribe antibiotics when they are needed. The “Guarantee” poster could be personalized with the provider’s photo and signature. Some providers indicate patients expect antibiotics even if the illness is viral (where antibiotics would not be effective) so NYSDOH developed a “Get Smart Guarantee” palm card [PDF – 1 page]. This takeaway serves in lieu of a prescription for antibiotics so patients understand their concerns have been heard and validated. The poster and palm card are offered in English and Spanish.
Utah Department of Health: Using Data to Identify Best and Worst Performing Clinics
The Utah Health Department shared data publicly on the Open Data Catalog website to show which clinics in the state had the best and worst performance on the HEDIS® measure: Avoidance of antibiotic treatment in adults with acute bronchitis (which usually does not require antibiotics). Utah used its All Payer Claims Database, which combines eligibility, medical claims, pharmacy claims, and provider files each month, to compile 2013-2014 data.
Healthcare Providers, Patients, and Families Play a Critical Role in Supporting Optimal Antibiotic Use and Preventing Infections in Outpatient Settings.
What can healthcare providers do to support appropriate antibiotic use and prevent infections in outpatient settings?
- Follow clinical guidelines when prescribing antibiotics.
- Use the right antibiotic, at the right dose, for the right duration, and at the right time.
- Place written commitments in support of improving antibiotic use in exam rooms to help facilitate patient communication about appropriate antibiotic use.
- Give patients information and materials on appropriate antibiotic use to reference. See examples of print materials for everyone.
- Talk to patients and families about when antibiotics are and are not needed, and discuss possible harms such as allergic reactions, C. difficile, and antibiotic-resistant infections.
- Ask patients if they have ever had a C. difficile infection, and tailor antibiotic treatment accordingly.
- For patients with conditions that usually resolve without antibiotic treatment:
- Talk to patients about ways to relieve their symptoms without antibiotics.
- Discuss a clear plan for follow-up if symptoms worsen or do not improve.
- Be aware of antibiotic resistance patterns in your community; use the data to inform prescribing decisions.
- Follow hand hygiene and other infection prevention measures with every patient.
What can patients and families do to support appropriate antibiotic use and prevent infections in outpatient settings?
- Talk to your healthcare provider about when antibiotics will and won’t help, and ask about antibiotic resistance.
- Talk to your healthcare provider about how to relieve symptoms.
- Take antibiotics only when prescribed and exactly as prescribed.
- Don’t save an antibiotic for later or share the drugs with someone else.
- Insist that everyone cleans their hands before touching you.
- Stay healthy and keep others healthy by cleaning hands, covering coughs, staying home when sick, and getting recommended vaccines.
- Page last reviewed: October 6, 2017
- Page last updated: October 6, 2017
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