Less than 2% of health care providers account for 25% of all pediatric antibiotic prescriptions in Tennessee, according to a study published in Infection Control & Hospital Epidemiology.
“These results echo what prior studies from the CDC have noted — especially in terms of high antibiotic prescribing states clustering in the southeastern United States — but give more detail on patient and provider demographics associated with higher antibiotic prescribing rates,” Sophie Katz, MD, MPH, assistant professor of pediatric infectious diseases and associate director of pediatric antimicrobial stewardship at Vanderbilt University Medical Center, told Healio. “We hope that these data might be also be useful for other high-prescribing states in the region.”
Katz and colleagues performed a cross-sectional, retrospective analysis of outpatient pediatric antibiotic prescriptions in Tennessee written for individuals aged 20 years or younger to identify provider and patient characteristics associated with high-volume antibiotic prescribing rates. They used the 2016 IQVIA Xponent database to identify 1,940,011 pediatric outpatient prescriptions and analyze characteristics such as county of prescription fill, patient age group, rural vs. urban county classification, provider type and physician specialty and years of practice.
The researchers found that Tennessee’s antibiotic prescribing rate was 1,165 per 1,000 children — 50% higher than the national average. The range of antibiotic prescribing rates was 39 to 2,482 per 1,000 population, with physicians writing the highest number of antibiotic prescriptions overall (54%). Pediatricians graduating from medical school before 2000 were more likely than those graduating after 2000 to be high antibiotic prescribers, and 360 (1.7%) of the 21,798 total prescribers were responsible for almost 25% of overall and broad-spectrum antibiotic prescriptions.
Antibiotic overprescribing is a concern because of the threat of antimicrobial resistance. The CDC estimated that 269 million antibiotic prescriptions were written from U.S. outpatient pharmacies in 2015 alone.
Katz noted a major limitation of the study was a lack of encounter-level data and indication of diagnosis, which left the researchers unable to determine whether or not antibiotic prescriptions were appropriate.
“We also did not have any data about different settings in which antibiotics were prescribed, like a provider’s office vs. a walk-in clinic or urgent care,” Katz said. “Other studies using different data sets, such as insurance-level data sets, might be able to address these limitations.” – by Eamon Dreisbach
CDC. Antibiotic Use in the United States, 2017: Progress and Opportunities. https://www.cdc.gov/antibiotic-use/stewardship-report/outpatient.html.
Katz SE, et al. Infect Control Hosp Epidemiol. 2020;doi:10.1017/ice.2019.338.
Disclosures: Katz reports receiving research funding from Roche and bioMerieux unrelated to this study. The other authors report no relevant financial disclosures.