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BMJ. 2018 Jul 27;362:k3155. doi: 10.1136/bmj.k3155.

Trends in outpatient antibiotic use and prescribing practice among US older adults, 2011-15: observational study.

Author information

1
Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA.
2
Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA.
3
Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
4
Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, ON, Canada.
5
Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.
6
Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA ygrad@hsph.harvard.edu.
7
Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.

Abstract

OBJECTIVE:

To identify temporal trends in outpatient antibiotic use and antibiotic prescribing practice among older adults in a high income country.

DESIGN:

Observational study using United States Medicare administrative claims in 2011-15.

SETTING:

Medicare, a US national healthcare program for which 98% of older adults are eligible.

PARTICIPANTS:

4.5 million fee-for-service Medicare beneficiaries aged 65 years old and older.

MAIN OUTCOME MEASUREMENTS:

Overall rates of antibiotic prescription claims, rates of potentially appropriate and inappropriate prescribing, rates for each of the most frequently prescribed antibiotics, and rates of antibiotic claims associated with specific diagnoses. Trends in antibiotic use were estimated by multivariable regression adjusting for beneficiaries' demographic and clinical covariates.

RESULTS:

The number of antibiotic claims fell from 1364.7 to 1309.3 claims per 1000 beneficiaries per year in 2011-14 (adjusted reduction of 2.1% (95% confidence interval 2.0% to 2.2%)), but then rose to 1364.3 claims per 1000 beneficiaries per year in 2015 (adjusted reduction of 0.20% over 2011-15 (0.09% to 0.30%)). Potentially inappropriate antibiotic claims fell from 552.7 to 522.1 per 1000 beneficiaries over 2011-14, an adjusted reduction of 3.9% (3.7% to 4.1%). Individual antibiotics had heterogeneous changes in use. For example, azithromycin claims per beneficiary decreased by 18.5% (18.2% to 18.8%) while levofloxacin claims increased by 27.7% (27.2% to 28.3%). Azithromycin use associated with each of the potentially appropriate and inappropriate respiratory diagnoses decreased, while levofloxacin use associated with each of those diagnoses increased.

CONCLUSION:

Among US Medicare beneficiaries, overall antibiotic use and potentially inappropriate use in 2011-15 remained steady or fell modestly, but individual drugs had divergent changes in use. Trends in drug use across indications were stronger than trends in use for individual indications, suggesting that guidelines and concerns about antibiotic resistance were not major drivers of change in antibiotic use.

PMID:
30054353
PMCID:
PMC6062849
DOI:
10.1136/bmj.k3155
[Indexed for MEDLINE]
Free PMC Article

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from the US National Institute of General Medical Sciences for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

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