Highlights
- •Forty percent of antibiotic prescriptions were not indicated for use.
- •Azithromycin was prescribed unnecessarily most often.
- •The correct antibiotic was prescribed when the syndrome met clinical guidance.
- •ICD-10-CM codes were unreliable in identifying outpatient infections.
Background
Outpatient prescriptions comprise 60% of antibiotic use. This study prospectively
identified inappropriate antibiotic use enabling a focused approach to outpatient
antimicrobial stewardship.
Methods
Outpatients at the Veterans Affairs Western New York Healthcare System were identified
via an electronic antibiotic alert from June 2017 to September 2017. Descriptive statistics
and multivariable logistic regression identified stewardship targets.
Results
Of the 1,063 patients, 40% of antibiotic prescriptions were not indicated. Urinary
tract infections (21%), bronchitis (20%), skin structure infections (17%), and sinusitis
(10%) were common causes of inappropriate antibiotic use. Azithromycin (37%) was prescribed
unnecessarily most often, followed by ciprofloxacin (16%), amoxicillin/clavulanate
(13%), and cephalexin (12%). The correct drug was chosen in 52%, dose in 81%, and
duration in 75% of patients. When the antibiotic was indicated, the correct drug was
2.9 times more likely to be prescribed and 2 times more likely to have the correct
duration and receive care in the emergency room.
Discussion
Focusing on 4 drugs; amoxicillin/clavulanate, azithromycin, ciprofloxacin, and cephalexin
accounted for 80% of unnecessary drug use. This study provides a guide to concentrate
efforts during implementation of an outpatient stewardship program.
Conclusions
Poor antibiotic prescribing was found in the outpatient setting. This study identifies
areas for improvement via stewardship.
Key Words
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Article info
Publication history
Published online: March 09, 2019
Footnotes
Funding/support: This material is the result of work supported with resources and the use of facilities at the Veterans Affairs Western New York Healthcare System.
The contents of this manuscript are not intended to represent the views of the Department of Veterans Affairs or the US government.
Conflicts of interest: None to report.
Identification
Copyright
© 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
