1910. Outpatient Macrolide Antibiotic Prescribing in the United States, 2008-2011
Session: Poster Abstract Session: Antibiotic Stewardship: Outpatient and ED
Saturday, October 29, 2016
Room: Poster Hall
  • Macrolide_Poster 10_18_2016_Layout D kfd.pdf (505.4 kB)
  • Background:

    Macrolides are infrequently recommended for treatment for common infections yet are commonly prescribed outpatient antibiotics. To guide outpatient stewardship efforts, our objectives were to identify top diagnoses associated with macrolide prescribing and examine the associations between provider specialty and macrolide selection. 


    The National Ambulatory Medical Care Survey from 2008–11 was used to identify outpatient visits with macrolide prescriptions.  We identified common diagnoses and classified them into 3 categories:  macrolides may be indicated (e.g., pneumonia), macrolides not recommended (e.g., acute otitis media), or antibiotics unnecessary (e.g., upper respiratory infection [URI]).  Among visits with antibiotics prescribed, multivariable logistic regression was used to examine the association between provider specialty and macrolide selection.


    In 2008-11, 9.0 million pediatric and 15.4 million adult physician office visits were associated with macrolide prescriptions annually.   Common visit diagnoses are shown (Table). Diagnoses for which macrolides are not recommended (sinusitis and acute otitis media) combined with diagnoses for which antibiotics are unnecessary (bronchitis and URI) accounted for 46% of adult and 55% of pediatric macrolide prescriptions. After controlling for age, diagnosis, and other patient characteristics, family practitioners had higher odds of selecting macrolides for children (adjusted odds ratio, 1.42, 95% confidence interval [CI] 1.05–1.94) than pediatricians. No specialty-level differences were identified for adults.


    Macrolides are frequently prescribed for conditions for which they are not recommended. Overuse of macrolides is an important target for antibiotic stewardship initiatives.

    Table. Common diagnoses for U.S. outpatient macrolide prescriptions, 2008–11

    Percent of macrolides prescribed (95% CI)




    Macrolides may be indicated


    6 (4–9)

    2 (2–3)


    14 (11–18)

    9 (7–11)

    Macrolides not recommended


    16 (12–21)

    19 (16–22)

    Acute otitis media

    16 (12–21)

    Antibiotics unnecessary


    13 (10–17)

    14 (12–17)


    10 (8–13)

    12 (9–15)

    *Columns may not add to 100%

    Guillermo Sanchez, PA-C, MPH, MSHS, Division of Healthcare Quality and Promotion, Centers for Disease Control and Prevention, Atlanta, GA, Daniel Shapiro, MD, Department of Pediatrics, Boston Children's Hospital, Boston, MA, Adam L. Hersh, MD, PhD, University of Utah School of Medicine, Salt Lake City, UT, Lauri Hicks, DO, Office of Antibiotic Stewardship, Centers for Disease Control and Prevention, Atlanta, GA and Katherine Fleming-Dutra, MD, Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA


    G. Sanchez, None

    D. Shapiro, None

    A. L. Hersh, Merck: Grant Investigator , Research grant

    L. Hicks, None

    K. Fleming-Dutra, None

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