BACKGROUND While antibiotics are life-saving drugs, their use is not without risk, including adverse events and antibiotic resistance. The majority of US antibiotic prescriptions are prescribed in outpatient settings, making outpatient antibiotic prescribing an important antibiotic stewardship target. The primary objective of this study was to describe trends in US outpatient oral antibiotic prescriptions from 2011-2016. METHODS We estimated annual oral antibiotic prescription rates using national prescription dispensing count data from IQVIA Xponent, divided by census estimates for 2011-2016. We calculated the ratio of broad- to narrow-spectrum prescriptions by dividing broad-spectrum prescription rates by narrow-spectrum prescription rates. We used Poisson models to estimate prevalence rate ratios, comparing 2011 and 2016 antibiotic prescription rates, and linear models to evaluate temporal trends throughout the study period. RESULTS Oral antibiotic prescription rates decreased 5%, from 877 prescriptions per 1000 persons in 2011 to 836 per 1000 persons in 2016. During this period, rates of prescriptions dispensed to children decreased 13%, while adult rates increased 2%. The ratio of broad- to narrow-spectrum antibiotics decreased from 1.62 in 2011 to 1.49 in 2016, driven by decreases in macrolides and fluoroquinolones. The proportion of prescriptions written by nurse practitioners and physician assistants increased during the study period; in 2016, these providers prescribed over one-quarter of all antibiotic prescriptions. CONCLUSIONS Outpatient antibiotic prescription rates, especially of broad-spectrum agents, have decreased in recent years. Clinicians who prescribe to adults, including nurse practitioners and physician assistants, are important targets for antibiotic stewardship.

中文翻译：

---

2011-2016年美国门诊抗生素处方的变化。

背景技术尽管抗生素是挽救生命的药物，但使用它们并非没有风险，包括不良事件和抗生素耐药性。大多数美国抗生素处方都是在门诊病人处方中制定的，这使得门诊病人处方抗生素成为重要的抗生素管理目标。这项研究的主要目的是描述2011-2016年美国门诊口服抗生素处方的趋势。方法我们使用IQVIA Xponent的国家处方分配计数数据估算了年度口服抗生素处方率，再除以2011-2016年的人口普查估计数。我们通过将广谱处方率除以窄谱处方率来计算广谱处方与窄谱处方的比率。我们使用泊松模型估算患病率，比较2011年和2016年的抗生素处方率以及线性模型以评估整个研究期间的时间趋势。结果口服抗生素处方率下降了5％，从2011年的每1000人877个处方下降到2016年的每1000人的836个处方。在此期间，分配给儿童的处方率下降了13％，而成人的处方率上升了2％。在大环内酯类和氟喹诺酮类药物减少的推动下，广谱和窄谱抗生素的比例从2011年的1.62下降到2016年的1.49。在研究期间，由执业护士和医师助理撰写的处方比例有所增加；在2016年，这些提供者开出了所有抗生素开处方的四分之一。结论门诊抗生素处方率，尤其是广谱药物的门诊抗生素处方率，近年来有所减少。开处方给成人的临床医生，包括执业护士和助教，是抗生素管理的重要对象。