ArticleAntimicrobial agents and chemotherapy2018
Prevalence of Inappropriate Antibiotic Prescribing in Primary Care Clinics within a Veterans Affairs Health Care System.
Article in Antimicrobial agents and chemotherapy, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 73 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
73 citing papers in PubMed, 1 synthesis or guideline pooled it, 115 citations in OpenAlex.
- Escherichia coli Resistance to Fluoroquinolones in Community-Acquired Uncomplicated Urinary Tract Infection in Women: a Systematic Review.Antimicrobial agents and chemotherapy · 2020Pooled it
- Early Symptom Response in Patients With Uncomplicated Urinary Tract Infection Treated With Gepotidacin or Nitrofurantoin: Pooled Analysis From Two Pivotal Phase 3 Studies.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Trial
- Appropriateness and Abuse of Antipyretics, Anti-Inflammatory Drugs and Antibiotics in Children and Adults.Antibiotics (Basel, Switzerland) · 2026Review
- Bacteriophage-mediated reduction of uropathogenicInfection and immunity · 2026Article
- Doctor-related Knowledge, Attitudes and Practices (KAP) factors influencing antibiotic prescribing for urinary tract infections in primary care in Singapore: a cross-sectional study.BMC primary care · 2026Article
- Antibiotic appropriateness among patients experiencing homelessness at an interprofessional student-run free clinic.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Isolation and partial characterization of antimicrobial peptide-enriched fractions from Parabacteroides distasonis.Scientific reports · 2025Article
- Knowledge, Attitudes, and Practices Regarding Antibiotic Use and Resistance: A Cross-Sectional Study from Oman.International journal of environmental research and public health · 2025Article
- Evaluating antimicrobial prescriptions in primary health care across an entire Brazilian city through the analysis of electronic medical records: where public health and data science converge.BMC medical informatics and decision making · 2025Article
- Bacteriophage-mediated reduction of uropathogenicbioRxiv : the preprint server for biology · 2025Article
- Pattern and appropriateness of antimicrobial prescription for acute respiratory tract infection in primary healthcare settings in Ethiopia.Antimicrobial resistance and infection control · 2025Article
- Machine learning for the prediction of urosepsis using electronic health record data.PLOS digital health · 2025Article
- Appropriateness of Antibiotic Prescription Among Children Under 5 Years: A Cross-Sectional Study in a Ghanaian Regional Hospital.Health science reports · 2025Article
- The Antimicrobial Resistance-Water-Corporate Interface: Exploring the Connections Between Antimicrobials, Water, and Pollution.Tropical medicine and infectious disease · 2025Review
- Do Hospitalized Adult Patients with Acute Pharyngotonsillitis Need Empiric Antibiotics? The Impact on Antimicrobial Stewardship.Microorganisms · 2025Article
- AI driven decision support reduces antibiotic mismatches and inappropriate use in outpatient urinary tract infections.NPJ digital medicine · 2025Article
- Development and validation of an antibiotic appropriateness metric for urinary tract infections and pyelonephritis in ambulatory settings.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Impact of an evidence-based order panel on antibiotic prescribing in ambulatory patients with cystitis.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- A Behavioral Analysis of Factors That Influence Antibiotic Prescribing in Hospitals: A Metasynthesis of Reviews.Open forum infectious diseases · 2025Review
- Antibiotic stewardship: what for?Frontiers in antibiotics · 2025Article
13 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Data are needed from outpatient settings to better inform antimicrobial stewardship. In this study, a random sample of outpatient antibiotic prescriptions by primary care providers (PCPs) at our health care system was reviewed and compared to consensus guidelines. Over 12 months, 3,880 acute antibiotic prescriptions were written by 76 PCPs caring for 40,734 patients (median panel, 600 patients; range, 33 to 1,547). PCPs ordered a median of 84 antibiotic prescriptions per 1,000 patients per year. Azithromycin (25.8%), amoxicillin-clavulanate (13.3%), doxycycline (12.4%), amoxicillin (11%), fluoroquinolones (11%), and trimethoprim-sulfamethoxazole (10.6%) were prescribed most commonly. Medical records corresponding to 300 prescriptions from 59 PCPs were analyzed in depth. The most common indications for these prescriptions were acute respiratory tract infection (28.3%), urinary tract infection (23%), skin and soft tissue infection (15.7%), and chronic obstructive pulmonary disease (COPD) exacerbation (6.3%). In 5.7% of cases, no reason for the prescription was listed. No antibiotic was indicated in 49.7% of cases. In 12.3% of cases, an antibiotic was indicated, but the prescribed agent was guideline discordant. In another 14% of cases, a guideline-concordant antibiotic was given for a guideline-discordant duration. Therefore, 76% of reviewed prescriptions were inappropriate. Ciprofloxacin and azithromycin were most likely to be prescribed inappropriately. A non-face-to-face encounter prompted 34% of prescriptions. The condition for which an antibiotic was prescribed was not listed in primary or secondary diagnosis codes in 54.5% of clinic visits. In conclusion, there is an enormous opportunity to reduce inappropriate outpatient antibiotic prescriptions.
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