Antibiotic Prescribing Rates Vary Across the US

Lauri A. Hicks, DO, captain, US Public Health Service, director, Office of Antibiotic Stewardship, medical director, Get Smart: Know When Antibiotics Work, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, discusses how antibiotic prescribing data vary across the United States.

Interview Transcript (slightly modified for readability)

“I became the medical director for the Get Smart: Know When Antibiotics Work program back in 2008, but it actually has been in place since 2003. We looked at data comparing the timeframe before the Get Smart program started, [to data from the] time after [and] more recently, and so 10 years later we’ve been able to look at prescribing changes over time, and what we’ve seen is that, in particular for kids, [there is] a 24% decrease in antibiotic prescribing for visits. That means there actually was behavior change—and we’re talking about patients [who] have already made it to the provider’s office.

We’ve seen a lot of improvements in pediatrics, where we have not seen as much improvement is for adult patients. When we look at prescribing data over time, the numbers and the prescriptions per population have remained pretty steady, and we actually have seen some increases in prescribing for older adults. Interestingly, there’s a lot of geographic variability in antibiotic prescribing, which has [been] seen to persist. We’ve started looking at these data initially in 2010, and more recently we’re still looking at variability in prescribing across the country. We see that prescribing is higher in the southern part in the United States, particularly in the Appalachian region than in other parts of the country. What is striking is that, actually, prescribing rates in some states are sometimes 2 times higher than prescribing rates in other states. For example, [in] West Virginia, which is the highest prescribing state, is more than double in terms of the prescribing rate compared to Alaska.

We do know that when we’ve looked at data on antibiotic prescribing for conditions that don’t warrant antibiotic therapy, like bronchitis, acute and complicated bronchitis, common cold, we see that there is a higher prescribing rate for these conditions in the south in the Appalachian region in those states where there are higher prescribing rates overall. There is some evidence of a little bit more inappropriate use [in those regions]; however, when we compare [the antibiotic prescribing] map to other maps, [such as] the map for obesity or the map for smoking, we see a lot of similarities; [therefore], there are some indications that the populations, in terms of the underlying health of the populations, could be different in West Virginia, the Appalachian region, the south, as compared to, [for example], the Pacific Northwest.”