Journal of General Internal Medicine

, Volume 33, Issue 7, pp 1060–1068 | Cite as

National Estimates of Emergency Department Visits for Antibiotic Adverse Events Among Adults—United States, 2011–2015

  • Andrew I. GellerEmail author
  • Maribeth C. Lovegrove
  • Nadine Shehab
  • Lauri A. Hicks
  • Mathew R. P. Sapiano
  • Daniel S. Budnitz
Original Research



Detailed, nationally representative data describing high-risk populations and circumstances involved in antibiotic adverse events (AEs) can inform approaches to prevention.


Describe US burden, rates, and characteristics of emergency department (ED) visits by adults for antibiotic AEs.


Nationally representative, public health surveillance of adverse drug events (National Electronic Injury Surveillance System-Cooperative Adverse Drug Event Surveillance [NEISS-CADES]) and a nationally projected database of dispensed prescriptions (QuintilesIMS), 2011–2015.


Antibiotic-treated adults (≥ 20 years) seeking ED care.

Main Measures

Estimated annual numbers and rates of ED visits for antibiotic AEs among outpatients treated with systemically administered antibiotics.

Key Results

Based on 10,225 cases, US adults aged ≥ 20 years made an estimated 145,490 (95% confidence interval, 115,279–175,701) ED visits for antibiotic AEs each year in 2011–2015. Antibiotics were implicated in 13.7% (12.3–15.2%) of all estimated adult ED visits for adverse drug events. Most (56.6%; 54.8–58.4%) antibiotic AE visits involved adults aged < 50 years, and 71.8% (70.4–73.1%) involved females. Accounting for prescriptions dispensed from retail and long-term care pharmacies, adults aged 20–34 years had twice the estimated rate of ED visits for oral antibiotic AEs compared with those aged ≥ 65 years (9.7 [7.6–11.8] versus 4.6 [3.6–5.7] visits per 10,000 dispensed prescriptions, respectively). Allergic reactions accounted for three quarters (74.3%; 70.0–78.6%) of estimated ED visits for antibiotic AEs. The three most frequently implicated antibiotic classes in ED visits for antibiotic AEs were oral sulfonamides (23.2%; 20.6–25.8%), penicillins (20.8%; 19.3–22.4%), and quinolones (15.7%; 14.2–17.1%). Per-prescription rates declined with increasing age group.


Antibiotics are a common cause of ED visits by adults for adverse drug events and represent an important safety issue. Quantifying risks of AEs from specific antibiotics for specific patient populations, such as younger adults, provides additional information to help clinicians assess risks versus benefits when making the decision to prescribe or not prescribe an antibiotic. AE rates may also facilitate communication with patients about antibiotic risks.


pharmaceutical care patient safety community health primary care evidence-based medicine 


Author Contributions

The authors thank Dr. Nina Weidle from Eagle Medical Services, LLC (contractor to CDC), Ms. Katie Rose, Ms. Sandra Goring, Ms. Arati Baral, and Mr. Alex Tocitu, from Northrop Grumman (contractor to CDC), for assistance with data coding and programming. The authors also thank Mr. Tom Schroeder, Ms. Elenore Sonski, Mr. Herman Burney, and data abstractors from the US Consumer Product Safety Commission, for their assistance with data acquisition.


This study was funded by the Federal government of the USA.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they do not have a conflict of interest.


Federal government employees had a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. However, the findings in and conclusions of this study are those of the authors and do not necessarily represent the official position of the US Centers for Disease Control and Prevention.

Prior Presentations


Supplementary material

11606_2018_4430_MOESM1_ESM.docx (22 kb)
ESM 1 (DOCX 22.2 kb)


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Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2018

Authors and Affiliations

  • Andrew I. Geller
    • 1
    Email author
  • Maribeth C. Lovegrove
    • 1
  • Nadine Shehab
    • 1
  • Lauri A. Hicks
    • 1
  • Mathew R. P. Sapiano
    • 1
  • Daniel S. Budnitz
    • 1
  1. 1.Division of Healthcare Quality Promotion Centers for Disease Control and Prevention (CDC)AtlantaUSA

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