The Costs of Inappropriate Outpatient Antibiotics

Reviewed by Erica Stohs, MD, MPH; University of Nebraska

This study provides a call to action for outpatient antibiotic stewardship by comparing adverse events and costs among patients prescribed appropriate vs inappropriate antibiotics. Investigators examined >3 million otherwise healthy adults aged 18-64 y from a commercial database who had a diagnosis of bacterial respiratory infection (pharyngitis or sinusitis) or a viral respiratory infection (influenza, viral URI, nonsuppurative otitis media, or bronchitis) between Apr 2016 – Sep 2018 who had not received antibiotics for 90 days. Appropriateness of antibiotics were based on guidelines for said infectious syndrome and authors noted that inappropriate antibiotics were prescribed to 43-56% with bacterial infections and 7-66% with viral infections with durations ranging between 5-14 days. Worst among diagnoses with inappropriate antibiotics was bronchitis at 66%. Not surprisingly, inappropriate antibiotics were associated with increased adverse drug events, including C diff and other gastrointestinal symptoms based on propensity score-weighted Cox proportional hazards. Thirty-day attributable healthcare expenditures were higher among adults who received inappropriate antibiotics for bacterial infections. These results are not surprising and strengthen the case for outpatient antimicrobial stewardship.

Butler AM, et al. “Comparative Safety and Attributable Healthcare Expenditures Following Inappropriate Versus Appropriate Outpatient Antibiotic Prescriptions Among Adults With Upper Respiratory Infections.” CID 2023;76(6):986-95.

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