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Drug Safety

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Changes in Outpatient Use of Antibiotics by Adults in the United States, 2006–2015

  • Mallika L. Mundkur
  • Jessica Franklin
  • Krista F. Huybrechts
  • Michael A. Fischer
  • Aaron S. Kesselheim
  • Jeffrey A. Linder
  • Joan Landon
  • Elisabetta Patorno
Original Research Article

Abstract

Introduction

Numerous initiatives over the past decade have targeted the problem of antibiotic overuse in the US; however, the cumulative impact of such initiatives upon recent patterns of use is not known.

Objectives

The aims of this study were to (1) describe general trends in outpatient antibiotic use among adults over the period 2006–2015; and (2) identify rapid shifts in use during this time period as potential indicators for key events.

Methods

This was an observational study set in the ambulatory setting. Patients ≥ 18 years of age were selected from the Optum Clinformatics Datamart™, a commercial insurance claims database. The outcome measures of interest were prescriptions filled/1000 enrolled individuals, by year or quarter. We used linear regression to identify trends in use over multiple years, and change-point regression to identify rapid shifts in use within individual years.

Results

From 2006 to 2015, antibiotic use declined significantly, decreasing by 12% for adults younger than 65 years of age (913–807 prescriptions/1000 individuals, p = 0.0001) and by 5% for adults ≥ 65 years of age (991–943 prescriptions/1000 individuals, p = 0.018). With change-point regression, we identified a number of rapid shifts in the use of specific antibiotic classes, such as downward shifts in the use of quinolones and macrolides during the second quarter of 2008 and 2013, respectively.

Conclusions

Over the period 2006–2015 outpatient use of antibiotics decreased substantially among adults. Rapid shifts in use occurring in 2008 and 2013 may reflect the presence of key drivers of change, such as abrupt changes in access to care or perceived antibiotic safety.

Notes

Author Contributions

MLM and EP were primarily responsible for the design of the study and drafting of the manuscript; MLM and JF were responsible for the statistical analyses; KH, MF, AK, and JL contributed to the design/manuscript revision; and JL performed extracts of the data from the Optum database.

Compliance with Ethical Standards

Funding

This study was supported by the Division of Pharmacoepidemiology and Pharmacoeconomics (Brigham and Women’s Hospital, Boston, MA, USA), the Agency for Healthcare Research and Quality R01HS024930 (MAF and JAL) and HHSP233201500020I (JAL). Dr. Kesselheim’s work in this area is supported by CeBIL (Collaborative Research Program for Biomedical Innovation Law), a scientifically independent collaborative research program supported by a Novo Nordisk Foundation Grant (NNF17SA0027784). Dr. Patorno was supported by a career development Grant (K08AG055670) from the National Institute on Aging.

Conflict of interest

Mallika L. Mundkur, Jessica Franklin, Krista Huybrechts, Michael A. Fischer, Aaron S. Kesselheim, Jeffrey A. Linder, Joan Landon, and Elisabetta Patorno have no conflicts of interest that are directly relevant to the content of this study.

Supplementary material

40264_2018_697_MOESM1_ESM.docx (100 kb)
Supplementary material 1 (DOCX 100 kb)

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Mallika L. Mundkur
    • 1
  • Jessica Franklin
    • 1
  • Krista F. Huybrechts
    • 1
  • Michael A. Fischer
    • 1
  • Aaron S. Kesselheim
    • 1
  • Jeffrey A. Linder
    • 2
  • Joan Landon
    • 1
  • Elisabetta Patorno
    • 1
  1. 1.Division of Pharmacoepidemiology and Pharmacoeconomics, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonUSA
  2. 2.Division of General Internal Medicine and GeriatricsNorthwestern University Feinberg School of MedicineChicagoUSA

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