CDC Antibiotic Use Data Shows Progress, But Significant Challenges Remain

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The Centers for Disease Control and Prevention (CDC) has issued a report on antibiotic use in the United States.

The report ­­­— Antibiotic Use in the United States: Progress and Opportunities, 2018 Update —is an update to the antibiotic stewardship report CDC issued in 2017.

Below are some of the key takeaways from this year's report.

1. Outpatient antibiotic prescribing remains a problem, although some improvement has been made. According to 2016 outpatient antibiotic prescribing data, about 47 million antibiotic courses are prescribed in doctors' offices and emergency departments annually for infections that do not require antibiotics. That's about 30% of all antibiotics prescribed. Some good news: Outpatient antibiotic prescribing has improved a bit, with a 5% national decrease from 2011 to 2016.

2. Hospitals are more committed to antibiotic stewardship. According to 2017 hospital antibiotic stewardship program data, the number of hospitals reporting an antibiotic stewardship program meeting all of CDC's "Core Elements of Hospital Antibiotic Stewardship Programs" almost doubled from 2014 to 2017. Slightly more than three out of every four acute-care hospitals reported uptake of all seven core elements. While that's encouraging, significant work remains: The national goal is 100% by 2020.

3. Urgent care centers are a significant source of unnecessary antibiotics for respiratory illnesses. A study of antibiotic prescribing for respiratory illnesses by four outpatient settings — urgent care centers, emergency departments (EDs), retail health clinics and traditional medical offices — found that urgent care centers prescribed antibiotics unnecessarily 46% of the time. This compared to 25% in EDs, 17% in medical offices and 14% in retail health clinics.

4. Fluoroquinolones prescribing remains problematic. A study found that fluoroquinolones are routinely and unnecessarily prescribed for urinary tract infections (UTIs) and respiratory conditions. About 5% of all fluoroquinolone antibiotics prescribed for adults in medical offices and EDs in 2014 were unnecessary; furthermore, about 20% of all fluoroquinolone prescriptions in these settings were not the recommended first-line treatment.

Fluoroquinolones are not the recommended first-line treatment for UTIs or sinusitis. Yet, these conditions accounted for an estimated 6.3 million prescriptions in 2014. Fluoroquinolones were the most commonly prescribed antibiotic for UTIs. Colds and bronchitis, which should never be treated with antibiotics, led to an estimated 1.6 million unnecessary fluoroquinolone prescriptions in medical offices and EDs.

5. A majority of antibiotic courses for sinus infections are longer than expected. A study found that nearly 70% of antibiotic courses for sinus infections were longer than recommended. Guidelines advise 5-7 days of antibiotic treatment for most sinus infections in adults. However, almost 70% of antibiotic prescriptions for sinus infections are for 10 days.

6. There is significant opportunity for improvement in antibiotic selection for children. A study found that azithromycin, a commonly prescribed antibiotic in children, is often prescribed when not recommended or when not the recommended first-line drug by clinical guidelines.