ArticleAntimicrobial stewardship & healthcare epidemiology : ASHE2026
The changing landscape of outpatient antibiotic prescriptions among advanced practice clinicians in the United States, 2011 and 2022.
Article in Antimicrobial stewardship & healthcare epidemiology : ASHE, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
6 authors.
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Abstract
Objective: Estimate changes in antibiotic prescribing among advanced practice clinicians (APCs)-nurse practitioners (NPs) and physician assistants (PAs)-compared to physicians in 2022 versus 2011 to inform antibiotic stewardship efforts. Methods: Retrospective descriptive analysis of antibiotic prescription rates for 2011 and 2022 using county-level prescription dispensing data by provider type from IQVIA Xponent® (numerator) and population census estimates (denominator). Prescribing rates among physicians and APCs (NPs and PAs) nationally, by state, and by rurality of county are reported. Result: Overall outpatient antibiotic prescribing rates in 2022 declined by 19.2% compared to 2011, from 877 to 709 prescriptions per 1000 population. The physician rate declined by 45% (628 to 345 per 1000 population), whereas the rate for APCs rose by 104% (124 to 253 per 1000 population), particularly for NPs (148% increase from 65 to 161 per 1000 population). The increase in NP prescribing rates was distinctly higher in seven contiguous Southeastern states (163 to 393 per 1000 population from 2011 to 2022, respectively), where rates were higher within rural counties (range, 385 to 651 per 1000 population by state in 2022). Conclusion: APCs accounted for 1 in 3 outpatient antibiotic prescriptions in 2022, more than doubling their rate per capita over the past decade. This increase was especially prominent for NPs, particularly within the Southeast region, likely reflecting their growing role as rural primary care clinicians. Integration of APCs for outpatient antibiotic stewardship efforts is essential.
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