Observational studyBMJ (Clinical research ed.)2018
Trends in outpatient antibiotic use and prescribing practice among US older adults, 2011-15: observational study.
Observational study in BMJ (Clinical research ed.), 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 43 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
43 citing papers in PubMed.
- Trial
- Education vs Clinician Feedback on Antibiotic Prescriptions for Acute Respiratory Infections in Telemedicine: a Randomized Controlled Trial.Journal of general internal medicine · 2021Trial
- Residency Competency Assessments and Early-Career Primary Care Physicians' Antibiotic Prescribing.JAMA network open · 2026Article
- Outpatient Antibiotic Dispensing Trends Across Canadian Provinces, 2012-2022: A Population-Based Descriptive Study.Cureus · 2026Article
- Trends in primary care antibiotic prescribing during the implementation of national stewardship policies: Türkiye, 2011-2019.Frontiers in microbiology · 2026Article
- Overview of Methods for Assessing Antimicrobial Use in Outpatient Settings in High-Income Countries: A Narrative Review.Antibiotics (Basel, Switzerland) · 2025Review
- A comprehensive descriptive, predictive, and prescriptive analysis of antibiotic products' demand pre-, amid, and post-COVID-19 in Iran.Scientific reports · 2025Article
- The Gut Microbiome and Its Impact on Mood and Decision-Making: A Mechanistic and Therapeutic Review.Nutrients · 2025Review
- The Prevalence of Stevens-Johnson Syndrome Complications due to Antiepileptic Drug Use: A Systematic Review and Meta-Analysis.International journal of preventive medicine · 2025Review
- Drivers of Geographic Patterns in Outpatient Antibiotic Prescribing in the United States.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2024Article
- Article
- Evaluation of Implementation and Effectiveness of China's Antibiotic Stewardship in the First Affiliated Hospital of Sun Yat-sen University.Antibiotics (Basel, Switzerland) · 2023Article
- Article
- Antibiotic Prescription in the Community-Dwelling Elderly Population in Lombardy, Italy: A Sub-Analysis of the EDU.RE.DRUG Study.Antibiotics (Basel, Switzerland) · 2022Article
- Antibiotic prescribing amongst South African general practitioners in private practice: an analysis of a health insurance database.JAC-antimicrobial resistance · 2022Article
- Effects of utilization management on health outcomes: evidence from urinary tract infections and community-acquired pneumonia.Expert review of pharmacoeconomics & outcomes research · 2022Article
- National Cohort Study of Homebound Persons Living With Dementia: Antibiotic Prescribing Trends and Opportunities for Antibiotic Stewardship.Open forum infectious diseases · 2022Article
- A Nonrestrictive Approach to Fluoroquinolone Stewardship at Two Community Hospitals.Open forum infectious diseases · 2022Article
- Appropriateness of Antibiotic Prescriptions in Chinese Primary Health Care and the Impact of the COVID-19 Pandemic: A Typically Descriptive and Longitudinal Database Study in Yinchuan City.Frontiers in pharmacology · 2022Article
- Antibiotic prescribing patterns in Emergency Department at Regional Hospital in South Africa.African health sciences · 2021Observational
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
Abstract
objectiveTo identify temporal trends in outpatient antibiotic use and antibiotic prescribing practice among older adults in a high income country.
designObservational study using United States Medicare administrative claims in 2011-15.
settingMedicare, a US national healthcare program for which 98% of older adults are eligible.
participants4.5 million fee-for-service Medicare beneficiaries aged 65 years old and older. MAIN OUTCOME MEASUREMENTS: Overall rates of antibiotic prescription claims, rates of potentially appropriate and inappropriate prescribing, rates for each of the most frequently prescribed antibiotics, and rates of antibiotic claims associated with specific diagnoses. Trends in antibiotic use were estimated by multivariable regression adjusting for beneficiaries' demographic and clinical covariates.
resultsThe number of antibiotic claims fell from 1364.7 to 1309.3 claims per 1000 beneficiaries per year in 2011-14 (adjusted reduction of 2.1% (95% confidence interval 2.0% to 2.2%)), but then rose to 1364.3 claims per 1000 beneficiaries per year in 2015 (adjusted reduction of 0.20% over 2011-15 (0.09% to 0.30%)). Potentially inappropriate antibiotic claims fell from 552.7 to 522.1 per 1000 beneficiaries over 2011-14, an adjusted reduction of 3.9% (3.7% to 4.1%). Individual antibiotics had heterogeneous changes in use. For example, azithromycin claims per beneficiary decreased by 18.5% (18.2% to 18.8%) while levofloxacin claims increased by 27.7% (27.2% to 28.3%). Azithromycin use associated with each of the potentially appropriate and inappropriate respiratory diagnoses decreased, while levofloxacin use associated with each of those diagnoses increased.
conclusionAmong US Medicare beneficiaries, overall antibiotic use and potentially inappropriate use in 2011-15 remained steady or fell modestly, but individual drugs had divergent changes in use. Trends in drug use across indications were stronger than trends in use for individual indications, suggesting that guidelines and concerns about antibiotic resistance were not major drivers of change in antibiotic use.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.