Fleming-Dutra and colleagues analyzed cross-sectional data from the Centers for Disease Control and Prevention’s 2010-2011 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, which established baseline rates for overall antibiotic prescribing and inappropriate antibiotic prescribing among non–federally employed office-based physicians as well as in emergency departments and outpatient departments situated in nonfederal general and short-stay hospitals.

Out of 184,032 ambulatory care visits sampled, 12.6% resulted in the prescription of antibiotics. Sinusitis, suppurative otitis media, and pharyngitis were the most common diagnoses associated with antibiotic prescribing, and rates were highest among children aged 0 through 2 years. Acute respiratory conditions (including sinusitis, suppurative and nonsuppurative otitis, pharyngitis, viral upper respiratory syndrome, bronchitis and bronchiolitis, asthma and allergy, influenza, viral and nonviral pneumonia) accounted for 221 antibiotic prescriptions per 1000 population, of which only half were deemed appropriate on the basis of national treatment guidelines. Across all ages and conditions, 353 of 506 (70%) antibiotic prescriptions per 1000 population were considered appropriate, whereas 30% of all oral antibiotics prescribed were inappropriate.

Although administrative data rely on the accuracy of physician diagnosis and coding for infectious disease conditions as well as the strength of the research’s sampling strategy, this study sheds new light on the overuse of antibiotics in ambulatory care settings. These findings may even underestimate the true scale of the problem. In the course of managing patient and family expectations and our own impulses to treat rather than not (be it conscious or unconscious), physicians and other healthcare providers often overdiagnose infections to justify the use of antibiotics. This study provides a sobering baseline reading of our national “addiction” to antibiotics, even for conditions unlikely to benefit from their use.

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Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011.
JAMA.  2016; 315(17):1864-73