October 01, 2012
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Antibiotic use among older adults highest in the South

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Recent data suggest that there are significant geographical variations in the prescription of antibiotics to outpatients.

“The regional differences did not seem to be explained simply by differences in the prevalence of underlying conditions,” Yuting Zhang, PhD, assistant professor in the department of health policy and management at the University of Pittsburgh, told Infectious Disease News.

Yuting Zhang, PhD 

Yuting Zhang

Zhang and colleagues used data from Medicare Part D from 2007 to 2009. They evaluated geographic variation at three different levels: across 306 Dartmouth Atlas of Health Care hospital referral regions; across 50 states and the District of Columbia; and four national regions — South, West, Midwest and Northeast.

Overall, the highest use of antibiotics was found in the South, which had a rate of 21.4% per quarter vs. 17.4% in the West and 19.2% in the Midwest. Among all regions, the rate of antibiotic use was higher during the first quarter of the year (January, February and March) and lowest in the third quarter (July, August and September).

The differences in antibiotic use are not explained by differences in the prevalence of bacterial pneumonia, acute nasopharyngitis and other acute respiratory tract infections. Although the Northeast had the highest prevalence of bacterial pneumonia, it had lowest use of antibiotics. In addition, the South, which had the highest rate of antibiotic use, had the highest prevalence of nonspecific acute respiratory tract infections.

“More targeted programs to reduce unnecessary antibiotic use can be implemented for areas with high rates of antibiotic use, such as states in the South,” Zhang said. “It might be necessary to target some quality improvement initiatives toward older adults. Quality improvement programs could set targets using the low-prescribing areas, like the states in the West, as a reference.”

Disclosure: Zhang has received grant funding from the Agency for Healthcare Research and Quality, the CMS, the Institute of Medicine and from the National Institute of Mental Health.