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Article
Antibiotic Use in Cold and Flu Season and Prescribing Quality: A Retrospective Cohort Study
Medical Care (2015)
  • Marcella Alsan, Stanford University
  • Nancy Morden, Dartmouth College
  • JOSHUA D GOTTLIEB, University of British Columbia
  • Weiping Zhou, Dartmouth College
  • Jonathan Skinner, Dartmouth College
Abstract
Background: Excessive antibiotic use in cold and flu season is costly and contributes to antibiotic resistance. The study objective was to develop an index of excessive antibiotic use in cold and flu season and determine its correlation with other indicators of prescribing quality. Methods and Findings: We included Medicare beneficiaries in the 40% random sample denominator file continuously enrolled in fee-for-service benefits for 2010 or 2011 (7,961,201 person-years) and extracted data on prescription fills for oral antibiotics that treat respiratory pathogens. We collapsed the data to the state level so they could be merged with monthly flu activity data from the Centers for Disease Control and Prevention. Linear regression, adjusted for state-specific mean antibiotic use and demographic characteristics, was used to estimate how antibiotic prescribing responded to state-specific flu activity. Flu-activity associated antibiotic use varied substantially across states—lowest in Vermont and Connecticut, highest in Mississippi and Florida. There was a robust positive correlation between flu-activity associated prescribing and use of medications that often cause adverse events in the elderly (0.755; P<0.001), whereas there was a strong negative correlation with beta-blocker use after a myocardial infarction (−0.413; P=0.003). Conclusions: Adjusted flu-activity associated antibiotic use was positively correlated with prescribing high-risk medications to the elderly and negatively correlated with beta-blocker use after myocardial infarction. These findings suggest that excessive antibiotic use reflects low-quality prescribing. They imply that practice and policy solutions should go beyond narrow, antibiotic specific, approaches to encourage evidence-based prescribing for the elderly Medicare population.
Keywords
  • antibiotics,
  • resistance,
  • over-prescribing
Publication Date
December, 2015
DOI
10.1097/MLR.0000000000000440
Citation Information
Marcella Alsan, Nancy Morden, JOSHUA D GOTTLIEB, Weiping Zhou, et al.. "Antibiotic Use in Cold and Flu Season and Prescribing Quality: A Retrospective Cohort Study" Medical Care Vol. 53 Iss. 12 (2015) p. 1066 - 1071
Available at: http://works.bepress.com/joshua_gottlieb/15/