Antibiotic prescribing for acute gastroenteritis during ambulatory care visits—United States, 2006–2015

Author:

Collins Jennifer P.ORCID,King Laura M.ORCID,Collier Sarah A.ORCID,Person John,Gerdes Megan E.,Crim Stacy M.ORCID,Bartoces Monina,Fleming-Dutra Katherine E.,Friedman Cindy R.,Francois Watkins Louise K.ORCID

Abstract

AbstractObjective:To describe national antibiotic prescribing for acute gastroenteritis (AGE).Setting:Ambulatory care.Methods:We included visits with diagnoses for bacterial and viral gastrointestinal infections from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (NAMCS/NHAMCS; 2006–2015) and the IBM Watson 2014 MarketScan Commercial Claims and Encounters Database. For NAMCS/NHAMCS, we calculated annual percentage estimates and 99% confidence intervals (CIs) of visits with antibiotics prescribed; sample sizes were too small to calculate estimates by pathogen. For MarketScan, we used Poisson regression to calculate the percentage of visits with antibiotics prescribed and 95% CIs, including by pathogen.Results:We included 10,210 NAMCS/NHAMCS AGE visits; an estimated 13.3% (99% CI, 11.2%–15.4%) resulted in antibiotic prescriptions, most frequently fluoroquinolones (28.7%; 99% CI, 21.1%–36.3%), nitroimidazoles (20.2%; 99% CI, 14.0%–26.4%), and penicillins (18.9%; 99% CI, 11.6%–26.2%). In NAMCS/NHAMCS, antibiotic prescribing was least frequent in emergency departments (10.8%; 99% CI, 9.5%–12.1%). Among 1,868,465 MarketScan AGE visits, antibiotics were prescribed for 13.8% (95% CI, 13.7%−13.8%), most commonly for Yersinia (46.7%; 95% CI, 21.4%–71.9%), Campylobacter (44.8%; 95% CI, 41.5%–48.1%), Shigella (39.7%; 95% CI, 35.9%–43.6%), typhoid or paratyphoid fever (32.7%; (95% CI, 27.2%–38.3%), and nontyphoidal Salmonella (31.7%; 95% CI, 29.5%–33.9%). Antibiotics were prescribed for 12.3% (95% CI, 11.7%–13.0%) of visits for viral gastroenteritis.Conclusions:Overall, ∼13% of AGE visits resulted in antibiotic prescriptions. Antibiotics were unnecessarily prescribed for viral gastroenteritis and some bacterial infections for which antibiotics are not recommended. Antibiotic stewardship assessments and interventions for AGE are needed in ambulatory settings.

Publisher

Cambridge University Press (CUP)

Subject

Infectious Diseases,Microbiology (medical),Epidemiology

Reference29 articles.

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2. Primary care physicians’ attitudes and perceptions towards antibiotic resistance and antibiotic stewardship: a national survey;Zetts;Open forum Infect Dis,2020

3. 9. National Center for Health Statistics. 2012 NAMCS Micro-Data File Documentation. Centers for Disease Control and Prevention website. https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/NAMCS/doc2012.pdf. Published 2021. Accessed November 17, 2021.

4. Increased incidence of antimicrobial-resistant nontyphoidal Salmonella infections, United States, 2004–2016;Medalla;Emerg Infect Dis,2021

5. Antibiotic use for emergency department patients with acute diarrhea: prescribing practices, patient expectations, and patient satisfaction;Karras;Ann Emerg Med,2003

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