Issue: July 2021
Disclosures: The authors report no relevant financial disclosures.
June 02, 2021
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Progress in reducing antibiotic use stalls despite stewardship push

Issue: July 2021
Disclosures: The authors report no relevant financial disclosures.
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Antibiotic use in the United States declined significantly from 1999 to 2018, though none of that decline occurred over the last decade despite a push for antimicrobial stewardship, researchers reported in Open Forum Infectious Diseases.

Antibiotic pills
The United States has not seen a decline in overall antibiotic use in the last 10 years.
Source: Adobe Stock.
Molly Petersen
Aaron A.R. Tobian

“Antibiotic resistance is an important global public health concern, and the U.S. had specified targets for reducing inappropriate antibiotic use in 2014. Thus, trends in antibiotic use are important for clinicians and public health professionals,” Molly Petersen, ScM, a data analyst in the department of pathology at Johns Hopkins University School of Medicine, and Aaron A.R. Tobian, MD, PhD, a professor of pathology, medicine, oncology and epidemiology at Johns Hopkins University School of Medicine and Bloomberg School of Public Health, told Healio.

Petersen, Tobian and colleagues conducted a cross-sectional study using data from the National Health and Nutrition Examination Surveys (NHANES) to calculate the prevalence of past 30-day nontopical outpatient antibiotic use and the change in prevalence during two time periods, from 1999-2002 to 2015-2018 and from 2007-2010 to 2015-2018.

The study demonstrated that the overall prevalence of past 30-day nontopical outpatient antibiotic use adjusted for age, sex, race/ethnicity, poverty status, time of year of the interview and insurance status declined from 4.9% (95% CI, 3.9%-5%) to 3% (95% CI, 2.6%-3%) from 1999-2002 to 2015-2018, with the largest decrease occurring among children aged 1 year or younger. However, it found no significant change (adjusted prevalence ratio [adjPR] = 1; 95% CI, 0.8-1.2) from 2007-2010 to 2015-2018.

The researchers found that age was significantly associated with antibiotic use ⎼⎼ noting that children aged 0 to 1 year had significantly higher antibiotic use than all other age categories above 6 years ⎼⎼ and that being non-Hispanic Black was negatively associated with antibiotic use compared with being non-Hispanic White (adjPR = 0.6; 95% CI, 0.4-0.8).

Antibiotic use is higher than recommended for appropriate community health. It is important for clinicians to remember their role in reducing antibiotic use,” Petersen and Tobian said. “We also hope this article adds to the literature for those who are involved with antibiotic stewardship programs.”