Session: Poster Abstract Session: Antibiotic Stewardship: Outpatient and ED
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.
Methods:
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.
Results:
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.
Conclusion:
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)
| |
Diagnosis
| Children
| Adults
|
Macrolides may be indicated | ||
Pneumonia | 6 (4–9) | 2 (2–3) |
Pharyngitis
| 14 (11–18) | 9 (7–11) |
Macrolides not recommended | ||
Sinusitis | 16 (12–21) | 19 (16–22) |
Acute otitis media | 16 (12–21) | — |
Antibiotics unnecessary | ||
Bronchitis/bronchiolitis | 13 (10–17) | 14 (12–17) |
URI | 10 (8–13) | 12 (9–15) |
*Columns may not add to 100%
Disclosures:
G. Sanchez,
None
A. L. Hersh, Merck: Grant Investigator , Research grant
L. Hicks, None
K. Fleming-Dutra, None