ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2024
Changes in the Appropriateness of US Outpatient Antibiotic Prescribing After the COVID-19 Outbreak: An Interrupted Time Series Analysis of 2016-2021 Data.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Saline nasal irrigation and gargling in COVID-19: Part II. Outcomes in Omicron and risk-benefit for self-care.Frontiers in public health · 2025Pooled it
- Adult U.S. Poison Center Exposure Case Trends Involving Nonprescription Dextromethorphan Amid the COVID-19 Pandemic: a Quasi-experimental Interrupted Time Series Study.Journal of medical toxicology : official journal of the American College of Medical Toxicology · 2026Article
- Paediatric outpatient antibiotic utilization patterns and use of healthcare services before, during and after the COVID-19 pandemic: interrupted time series analysis using data from Norway and Japan.The Journal of antimicrobial chemotherapy · 2026Article
- Article
- Inappropriate antibiotic prescribing for acute respiratory illnesses in outpatient settings in New York City, 2019-2022.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Clinicians' Reasons for Non-Visit-Based, No-Infectious-Diagnosis-Documented Antibiotic Prescribing: A Sequential Mixed-Methods Study.Antibiotics (Basel, Switzerland) · 2025Article
- Determining the impact of the COVID-19 pandemic on the consumption of antibiotics in Shaanxi province, China: an interrupted time-series analysis.Frontiers in public health · 2025Article
- Association of patient, physician and visit characteristics with inappropriate antibiotic prescribing in Japanese primary care: a cross-sectional study.BMJ public health · 2025Article
- Macrolide Resistance in theAntibiotics (Basel, Switzerland) · 2024Article
- Ambulatory antibiotic prescription rates for acute respiratory infection rebound two years after the start of the COVID-19 pandemic.PloS one · 2024Article
Corrections and comments
- Erratum issued
Authors and funding
4 authors.
Funding
Abstract
backgroundNo national study has evaluated changes in the appropriateness of US outpatient antibiotic prescribing across all conditions and age groups after the coronavirus disease 2019 (COVID-19) outbreak in March 2020.
methodsThis was an interrupted time series analysis of Optum's de-identified Clinformatics Data Mart Database, a national commercial and Medicare Advantage claims database. Analyses included prescriptions for antibiotics dispensed to children and adults enrolled during each month during 2017-2021. For each prescription, we applied our previously developed antibiotic appropriateness classification scheme to International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes on medical claims occurring on or during the 3 days prior to dispensing. Outcomes included the monthly proportion of antibiotic prescriptions that were inappropriate and the monthly proportion of enrollees with ≥1 inappropriate prescription. Using segmented regression models, we assessed for level and slope changes in outcomes in March 2020.
resultsAnalyses included 37 566 581 enrollees, of whom 19 154 059 (51.0%) were female. The proportion of enrollees with ≥1 inappropriate prescription decreased in March 2020 (level decrease: -0.80 percentage points [95% confidence interval {CI}, -1.09% to -.51%]) and subsequently increased (slope increase: 0.02 percentage points per month [95% CI, .01%-.03%]), partly because overall antibiotic dispensing rebounded and partly because the proportion of antibiotic prescriptions that were inappropriate increased (slope increase: 0.11 percentage points per month [95% CI, .04%-.18%]). In December 2021, the proportion of enrollees with ≥1 inappropriate prescription equaled the corresponding proportion in December 2019.
conclusionsDespite an initial decline, the proportion of enrollees exposed to inappropriate antibiotics returned to baseline levels by December 2021. Findings underscore the continued importance of outpatient antibiotic stewardship initiatives.
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