ArticleBMJ (Clinical research ed.)2019
Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study.
Article in BMJ (Clinical research ed.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 36 papers, 1 of them a synthesis that pooled it.
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Who cites it
36 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Factors influencing physicians' antimicrobial prescribing decisions: A systematic review of qualitative studies.British journal of clinical pharmacology · 2025Pooled it
- Article
- Development and assessment of the outpatient module of the Global-PPS: a standardized approach for measuring outpatient antimicrobial prescribing.JAC-antimicrobial resistance · 2025Article
- A Pilot Study Evaluating the Impact of an Algorithm-Driven Protocol on Guideline-Concordant Antibiotic Prescribing in a Rural Primary Care Setting.Pharmacy (Basel, Switzerland) · 2025Article
- Outpatient antibiotic stewardship during the COVID-19 era: analysis of prescribing trends and guideline compliance.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2025Article
- Impact of the US Food and Drug Administration warning regarding increased risk of aortic aneurysms or aortic dissections on fluoroquinolone prescribing trends.BMJ open quality · 2024Article
- Decreases and Pronounced Geographic Variability in Antibiotic Prescribing in Medicaid.Pharmacy (Basel, Switzerland) · 2024Article
- Appropriateness of Antibiotic Prescribing in US Emergency Department Visits, 2016-2021.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Article
- Antibiotic prescription for outpatients with influenza and subsequent hospitalisation: A cohort study using insurance data.Influenza and other respiratory viruses · 2023Article
- Do clinical and communication skills scores on credentialing exams predict potentially inappropriate antibiotic prescribing?BMC medical education · 2023Article
- Choosing Wisely interventions to reduce antibiotic overuse in the safety net.The American journal of managed care · 2023Article
- Joining Forces against Antibiotic Resistance: The One Health Solution.Pathogens (Basel, Switzerland) · 2023Review
- Acute Respiratory Infection Incidence and Outpatient Antibiotic Prescription Patterns in People With or Without Human Immunodeficiency Virus Infection: A Virtual Cohort Study.Open forum infectious diseases · 2023Article
- A scoping review and behavioural analysis of factors underlying overuse of antimicrobials.JAC-antimicrobial resistance · 2023Article
- Evaluation of Implementation and Effectiveness of China's Antibiotic Stewardship in the First Affiliated Hospital of Sun Yat-sen University.Antibiotics (Basel, Switzerland) · 2023Article
- Antibiotic prescription patterns in patients with suspected urinary tract infections in Ecuador.PloS one · 2023Article
- Determinants of the Empiric Use of Antibiotics by General Practitioners in South Africa: Observational, Analytic, Cross-Sectional Study.Antibiotics (Basel, Switzerland) · 2022Article
- Management of acute diarrhea in the emergency department of a tertiary care university medical center.The Journal of international medical research · 2022Article
- Analyzing Unnecessary Imaging for Low Back Pain in Nebraska from a Statewide Health Information Exchange.Journal of medical systems · 2022Article
- Using audit and feedback to encourage primary healthcare prescribers to record indications for antimicrobial prescriptions: a quality improvement initiative.BMJ open quality · 2022Article
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo identify the frequency with which antibiotics are prescribed in the absence of a documented indication in the ambulatory care setting, to quantify the potential effect on assessments of appropriateness of antibiotics, and to understand patient, provider, and visit level characteristics associated with antibiotic prescribing without a documented indication.
designCross sectional study.
setting2015 National Ambulatory Medical Care Survey.
participants28 332 sample visits representing 990.9 million ambulatory care visits nationwide.
main outcome measuresOverall antibiotic prescribing and whether each antibiotic prescription was accompanied by appropriate, inappropriate, or no documented indication as identified through ICD-9-CM (international classification of diseases, 9th revision, clinical modification) codes. Survey weighted multivariable logistic regression was used to evaluate potential risk factors for receipt of an antibiotic prescription without a documented indication.
resultsAntibiotics were prescribed during 13.2% (95% confidence interval 11.6% to 13.7%) of the estimated 990.8 million ambulatory care visits in 2015. According to the criteria, 57% (52% to 62%) of the 130.5 million prescriptions were for appropriate indications, 25% (21% to 29%) were inappropriate, and 18% (15% to 22%) had no documented indication. This corresponds to an estimated 24 million prescriptions without a documented indication. Being an adult male, spending more time with the provider, and seeing a non-primary care specialist were significantly positively associated with antibiotic prescribing without an indication. Sulfonamides and urinary anti-infective agents were the antibiotic classes most likely to be prescribed without documentation.
conclusionsThis nationally representative study of ambulatory visits identified a large number of prescriptions for antibiotics without a documented indication. Antibiotic prescribing in the absence of a documented indication may severely bias national estimates of appropriate antibiotic use in this setting. This study identified a wide range of factors associated with antibiotic prescribing without a documented indication, which may be useful in directing initiatives aimed at supporting better documentation.
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