Table 1.
Annual Visit and Estimated Appropriate Numbers of Antibiotic Prescriptions per 1000 Population and Percentage Reduction Targets by Age Group and Condition, National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, 2010–2011, 2012–2013, and 2014–2015
| 2010–2011 |
2012–2013 |
2014–2015 |
|||||||
|---|---|---|---|---|---|---|---|---|---|
| Diagnosis | Estimated Annual No. of Antibiotic Prescriptions per 1000 Populationa (95% Cl) | Estimated Annual No. of Necessary Antibiotic Prescriptions per 1000 Populationb | Percentage Unnecessary | Estimated Annual No. of Antibiotic Prescriptions per 1000 Populationa (95% Cl) | Estimated Annual No. of Necessary Antibiotic Prescriptions per 1000 Populationc | Percentage Unnecessary | Estimated Annual No. of Antibiotic Prescriptions per 1000 Populationa (95% Cl) | Estimated Annual No. of Necessary Antibiotic Prescriptions per 1000 Populationc | Percentage Unnecessary |
| Children aged 0–19 y | |||||||||
| All ARIsd | 370 (307–433) | 225 | 39% | 266 (240–292) | 197 | 26% | 252 (215–290) | 173 | 31% |
| Sinusitis | 60 (45–75) | 52 | 13% | 46 (39–54) | 46 | 0% | 37 (25–49) | 37 | 0% |
| Suppurative OM | 134 (108–160) | 101 | 25% | 93 (81–105) | 93 | 0% | 85 (68–102) | 85 | 0% |
| Pharyngitis | 77 (62–93) | 53 | 31% | 59 (51–67) | 45 | 24% | 65 (48–82) | 40 | 39% |
| Antibiotic-inappropriate ARIse | 80 (59–100) | 0 | 100% | 55 (47–63) | 0 | 100% | 54 (40–68) | 0 | 100% |
| Pneumonia | 20 (14–25) | 20 | 0% | 12 (10–15) | 12 | 0% | 11 (8–15) | 11 | 0% |
| Other conditionsf | 200 (166–233) | 165 | 18% | 167 (151–183) | 157 | 6% | 157 (135–179) | 157 | 0% |
| UTI | 20 (14–27) | 20 | 0% | 13 (11–16) | 13 | 0% | 17 (10–25) | 17 | 0% |
| Miscellaneous bacterial infections | 18 (11–24) | 18 | 0% | 16 (12–20) | 16 | 0% | 17 (11–23) | 17 | 0% |
| Remaining other conditionsg | 162 (135–189) | 127 | 22% | 137 (123–151) | 127 | 7% | 123(104–141) | 123 | 0% |
| Totalh | 570 (477–663) | 390 | 32% | 433 (396–470) | 354 | 18% | 409 (356–463) | 330 | 19% |
| Adults aged 20–64 y | |||||||||
| All ARIsd | 133 (109–157) | 40 | 70% | 108 (99–117) | 39 | 64% | 109 (87–131) | 36 | 67% |
| Sinusitis | 48 (38–59) | 23 | 52% | 36 (32–40) | 23 | 36% | 41 (30–53) | 23 | 44% |
| Suppurative OM | 7 (5–10) | 5 | 29% | 6(5–7) | 5 | 17% | 6 (3–9) | 5 | 17% |
| Pharyngitis | 25 (19–31) | 6 | 76% | 19 (16–22) | 6 | 68% | 18(11–24) | 5 | 72% |
| Antibiotic-inappropriate ARIse | 47 (37–57) | 0 | 100% | 42 (37–47) | 0 | 100% | 41 (31–50) | 0 | 100% |
| Pneumonia | 5(3–7) | 5 | 0% | 5 (4–6) | 5 | 0% | 3 (2–4) | 3 | 0% |
| Other conditionsf | 237 (199–276) | 203 | 14% | 231 (215–247) | 201 | 13% | 272 (235–309) | 207 | 24% |
| UTI | 31 (25–38) | 31 | 0% | 28 (24–31 ) | 28 | 0% | 32 (25–40) | 32 | 0% |
| Miscellaneous bacterial infections | 9 (7–12) | 9 | 0% | 10 (8–13) | 10 | 0% | 12 (7–16) | 12 | 0% |
| Remaining other conditionsg | 197 (164–229) | 163 | 17% | 193 (179–207) | 163 | 16% | 228(197–259) | 163 | 29% |
| Totalh | 370 (311–429) | 243 | 34% | 339 (318–361) | 240 | 29% | 381 (331–431) | 243 | 36% |
| Adults aged ≥65 y | |||||||||
| All ARIsd | 123 (95–151) | 63 | 49% | 111 (98–125) | 55 | 50% | 96 (76–115) | 44 | 54% |
| Sinusitis | 40 (28–51 ) | 40 | 0% | 36 (28–44) | 36 | 0% | 25(18–33) | 25 | 0% |
| Suppurative OM | … | … | … | … | … | … | … | 0 | … |
| Pharyngitis | … | … | … | 5(3–7) | … | … | … | … | … |
| Antibiotic-inappropriate ARIse | 60 (40–79) | 0 | 100% | 56 (46–65) | 0 | 100% | 52 (36–69) | 0 | 100% |
| Pneumonia | 11 (6–16) | 11 | 0% | 12 (8–15) | 12 | 0% | 9(5–12) | 9 | 0% |
| Other conditionsf | 445 (364–525) | 413 | 7% | 430 (393–468) | 405 | 6% | 453 (401–505) | 411 | 9% |
| UTI | 59 (43–73) | 59 | 0% | 55 (46–65) | 55 | 0% | 63 (44–83) | 63 | 0% |
| Miscellaneous bacterial infections | … | … | … | 11 (6–16) | 11 | 0% | … | 0 | … |
| Remaining other conditionsg | 371 (302–440) | 339 | 9% | 364 (330–398) | 339 | 7% | 381 (334–428) | 339 | 11% |
| Totalh | 568 (470–666) | 476 | 16% | 542 (501–583) | 461 | 15% | 549 (492–606) | 455 | 17% |
| All ages | |||||||||
| All ARIsd | 196(166–226) | 93 | 53% | 150(140–160) | 83 | 45% | 144 (126–163) | 73 | 49% |
| Other conditionsf | 254(215–293) | 220 | 13% | 242 (227–256) | 217 | 10% | 268 (241–295) | 224 | 16% |
| Totalh | 450 (383–516) | 313 | 30% | 392 (372–412) | 301 | 23% | 413 (374–451 ) | 296 | 28% |
Abbreviations: …, insufficient data for calculation; ARI, acute respiratory syndrome; Cl, confidence interval; OM, otitis media; UTI, urinary tract infection.
Mean annual population from US Census estimates of the civilian noninstitutional population [8]. Children aged 0–19 years: 2010–2011, 82 713 408; 2012–2013, 82 090 200; 2014–2015, 81 844 000. Adults aged 20–64 years: 2010–2011, 182 973 664; 2012–2013, 185 346 064; 2014–2015, 187 477 760. Adults aged ɥ65 years: 2010–2011, 39 622 492; 2012–2013, 42 625 840; 2014–2015, 45 688 596. Total population (all ages): 2010–2011, 305 309 564; 2012–2013, 310 062 104; 2014–2015, 315 010 356.
Target for sinusitis, acute otitis media (AOM), and remaining other conditions are based on lowest-prescribing regions for condition and age group (Supplementary Table 1). For pharyngitis, target is based on the estimated prevalence of group A streptococcal pharyngitis among all pharyngitis visits based on a large study (among adults) and a meta-analysis among children (37% of pharyngitis visits for children aged 0–19 years, 18% of pharyngitis visits adults aged 20–64 years; no change for adults aged ≥65 years) [9, 10],Target is no antibiotics for antibiotic-inappropriate ARIs.Target is no change in antibiotic prescribing rates for pneumonia, UTI, and miscellaneous bacterial infections.
Targets for sinusitis, AOM, and remaining other conditions are based on 2010–2011 estimated appropriate rates, except where observed values are below the 2010–2011 estimated appropriate prescribing rates, in which case no further reductions are targeted. Target for pharyngitis is based on the estimated prevalence of group A streptococcal pharyngitis among all pharyngitis visits based on a large study (among adults) and a meta-analysis among children (37% of pharyngitis visits for children aged 0–19 years, 18% of pharyngitis visits adults aged 20–64 years; no change for adults aged ≥65 years) [9, 10], Target is no antibiotics for antibiotic-inappropriate ARIs, and no change in antibiotic prescribing rates for pneumonia, UTI, and miscellaneous bacterial infections.
AII ARIs include AOM, nonsuppurative OM, sinusitis, pharyngitis, pneumonia, bronchitis, bronchiolitis, viral upper respiratory infection, influenza, asthma, allergy, and viral pneumonia.
Antibiotic-inappropriate ARIs are defined as asthma, allergy, bronchitis, bronchiolitis, influenza, nonsuppurative OM, viral upper respiratory infection, and viral pneumonia. Bronchitis and bronchiolitis include visits with bronchitis (not specified as acute or chronic), acute bronchitis, and acute bronchiolitis, but exclude visits in which the second or third diagnosis was chronic bronchitis, emphysema, or chronic obstructive pulmonary disease.
Other conditions excluding ARIs.
Remaining other conditions exclude ARIs, UTIs, and miscellaneous bacterial infections.
Sum of all ARIs and other conditions.