National Estimates of Emergency Department Visits for Antibiotic Adverse Events Among Adults—United States, 2011–2015
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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.
Estimated annual numbers and rates of ED visits for antibiotic AEs among outpatients treated with systemically administered antibiotics.
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.
KEY WORDSpharmaceutical care patient safety community health primary care evidence-based medicine
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.
- 1.QuintilesIMS Institute. Medicines Use and Spending in the U.S. A Review of 2016 and Outlook to 2021. 2016. https://www.iqvia.com/en/institute/reports/medicines-use-and-spending-in-the-us-a-review-of-2016. Accessed February 22, 2018.
- 2.US Department of Health and Human Services, Centers for Disease Control and Prevention. Outpatient antibiotic prescriptions—United States, 2014. 2016. https://www.cdc.gov/antibiotic-use/community/pdfs/Annual-ReportSummary_2014.pdf. Accessed February 22, 2018.
- 3.US Department of Health and Human Services, Centers for Disease Control and Prevention. Be Antibiotics Aware: Smart Use, Best Care. https://www.cdc.gov/antibiotic-use/. Accessed February 22, 2018.
- 7.US Department of Health and Human Services, Centers for Disease Control and Prevention. Antibiotic resistance threats in the United States, 2013. 2013. https://www.cdc.gov/drugresistance/threat-report-2013/. Accessed February 22, 2018.
- 10.US Department of Health and Human Services, Centers for Disease Control and Prevention. Office-related antibiotic prescribing for persons aged ≤14 years--United States, 1993-1994 to 2007-2008. MMWR Morb Mortal Wkly Rep. 2011;60(34):1153–6.Google Scholar
- 13.Dempsey PP, Businger AC, Whaley LE, Gagne JJ, Linder JA. Primary care clinicians’ perceptions about antibiotic prescribing for acute bronchitis: a qualitative study. BMC Fam Pract. 2014;15(194):1–10.Google Scholar
- 14.Stearns CR, Gonzales R, Camargo CA, Jr, Maselli J, Metlay JP. Antibiotic prescriptions are associated with increased patient satisfaction with emergency department visits for acute respiratory tract infections. Acad Emerg Med. 2009;16(10):934–41.Google Scholar
- 16.Gonzales R, Steiner JF, Maselli J, Lum A, Barrett PH, Jr Impact of reducing antibiotic prescribing for acute bronchitis on patient satisfaction. Eff Clin Pract. 2001;4(3):105–11.Google Scholar
- 25.US Department of Health and Human Services, Centers for Disease Control and Prevention. Distinguishing public health research and public health nonresearch. 2010. http://www.cdc.gov/od/science/integrity/docs/cdc-policy-distinguishing-public-health-research-nonresearch.pdf. Accessed February 22, 2018.
- 27.Schroeder T, Ault K. The NEISS sample (design and implementation) 1997 to present. http://www.cpsc.gov//PageFiles/106617/2001d011-6b6.pdf. Accessed February 22, 2018.
- 28.US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. CDC WONDER: Bridged-race vintage 2015 postcensal population estimates. 2016. http://wonder.cdc.gov/bridged-race-v2015.html. Accessed February 22, 2018.
- 30.Roberts RM, Albert AP, Johnson DD, Hicks LA. Can Improving Knowledge of Antibiotic-Associated Adverse Drug Events Reduce Parent and Patient Demand for Antibiotics? Health Serv Res Manag Epidemiol 2015;2:1–5.Google Scholar
- 33.Manuel JI. Racial/Ethnic and Gender Disparities in Health Care Use and Access. Health services research. 2017 May 8 [Epub ahead of print].Google Scholar