Older male doctors in small Southern practices prescribe most antibiotics

Photo of Lauri Hicks
Lauri A. Hicks

Outpatient antibiotic use — much of it unnecessary — is a main driver of antibiotic resistance. But which physicians in the United States are responsible for prescribing the most antibiotics? According to a new CDC-funded study, the answer may be older men in small Southern practices.

For the study, Lauri A. Hicks, DO, director of the CDC’s Office of Antibiotic Stewardship, and colleagues analyzed antibiotic prescription data from U.S. community pharmacies and physician data from the AMA to determine physician characteristics that are associated with higher volumes of antibiotic prescribing. What they found is that physicians who are male, older than age 40 years, located in the South and part of a one- or two-physician practice prescribe a higher volume of antibiotics than their peers by specialty.

Hicks and colleagues said the findings — based on prescriptions written in 2011 by almost 110,000 family practitioners, internists and pediatricians — can help direct antimicrobial stewardship efforts, which have traditionally been focused on hospital use.

“It’s important to reach these physicians to identify opportunities to improve antibiotic use and optimize patient care,” Hicks told Infectious Disease News. “We need innovative approaches to antibiotic stewardship that reach beyond hospitals and large heath systems to include independent, small outpatient practices.”

Among the findings, Hicks and colleagues reported that the median number of antibiotic prescriptions written per physician in all three specialties increased with each decade since medical school graduation. For instance, pediatricians who were out of medical school for 5 to 10 years wrote a median of 250 antibiotic prescriptions in 2011 compared with 523 that were written by pediatricians who had been out of medical school for 30 years or more.

Infographic
Source: Fleming-Dutra KE, et al. Open Forum Infect Dis. 2017;doi:10.1093/ofid/ofx279.

“These analyses demonstrate that physicians who have been out of medical school longer tend to prescribe more antibiotics, but we don’t know why,” Hicks said.

In terms of age, median antibiotic prescriptions peaked among pediatricians aged between 40 and 50 years. Median antibiotic prescriptions were higher among men than women in each specialty — and highest among male pediatricians. For each specialty, they were highest in the South compared with the West, Midwest and Northeast.

Among the limitations of their study, Hicks and colleagues said they could not assess the appropriateness of the antibiotics that were prescribed because the data did not include information regarding the diagnoses of patients.

“It is possible that these physicians see higher volumes of patients, which would affect their volume of antibiotic prescribing,” Hicks said. “It is also possible that there are cultural differences that affect how physicians prescribe antibiotics and whether they follow current, evidence-based treatment recommendations. Additional research can help us understand what is driving the higher volume of antibiotic prescribing among these groups of physicians and inform antibiotic stewardship efforts.” – by Gerard Gallagher

Reference:

Fleming-Dutra KE, et al. Open Forum Infect Dis. 2017;doi:10.1093/ofid/ofx279.

Disclosures: The authors report no relevant financial disclosures.

Photo of Lauri Hicks
Lauri A. Hicks

Outpatient antibiotic use — much of it unnecessary — is a main driver of antibiotic resistance. But which physicians in the United States are responsible for prescribing the most antibiotics? According to a new CDC-funded study, the answer may be older men in small Southern practices.

For the study, Lauri A. Hicks, DO, director of the CDC’s Office of Antibiotic Stewardship, and colleagues analyzed antibiotic prescription data from U.S. community pharmacies and physician data from the AMA to determine physician characteristics that are associated with higher volumes of antibiotic prescribing. What they found is that physicians who are male, older than age 40 years, located in the South and part of a one- or two-physician practice prescribe a higher volume of antibiotics than their peers by specialty.

Hicks and colleagues said the findings — based on prescriptions written in 2011 by almost 110,000 family practitioners, internists and pediatricians — can help direct antimicrobial stewardship efforts, which have traditionally been focused on hospital use.

“It’s important to reach these physicians to identify opportunities to improve antibiotic use and optimize patient care,” Hicks told Infectious Disease News. “We need innovative approaches to antibiotic stewardship that reach beyond hospitals and large heath systems to include independent, small outpatient practices.”

Among the findings, Hicks and colleagues reported that the median number of antibiotic prescriptions written per physician in all three specialties increased with each decade since medical school graduation. For instance, pediatricians who were out of medical school for 5 to 10 years wrote a median of 250 antibiotic prescriptions in 2011 compared with 523 that were written by pediatricians who had been out of medical school for 30 years or more.

Infographic
Source: Fleming-Dutra KE, et al. Open Forum Infect Dis. 2017;doi:10.1093/ofid/ofx279.

“These analyses demonstrate that physicians who have been out of medical school longer tend to prescribe more antibiotics, but we don’t know why,” Hicks said.

In terms of age, median antibiotic prescriptions peaked among pediatricians aged between 40 and 50 years. Median antibiotic prescriptions were higher among men than women in each specialty — and highest among male pediatricians. For each specialty, they were highest in the South compared with the West, Midwest and Northeast.

Among the limitations of their study, Hicks and colleagues said they could not assess the appropriateness of the antibiotics that were prescribed because the data did not include information regarding the diagnoses of patients.

“It is possible that these physicians see higher volumes of patients, which would affect their volume of antibiotic prescribing,” Hicks said. “It is also possible that there are cultural differences that affect how physicians prescribe antibiotics and whether they follow current, evidence-based treatment recommendations. Additional research can help us understand what is driving the higher volume of antibiotic prescribing among these groups of physicians and inform antibiotic stewardship efforts.” – by Gerard Gallagher

Reference:

Fleming-Dutra KE, et al. Open Forum Infect Dis. 2017;doi:10.1093/ofid/ofx279.

Disclosures: The authors report no relevant financial disclosures.