Sohn Minji, Pontefract Benjamin, Dahal Kushal, Klepser Michael
College of Pharmacy, Ferris State University, Big Rapids, Michigan, USA.
Collaborative to Advance Pharmacy Enterprises (CAPE), Ferris State University, Grand Rapids, Michigan, USA.
Antimicrob Steward Healthc Epidemiol. 2025 Aug 4;5(1):e168. doi: 10.1017/ash.2025.10081. eCollection 2025.
To analyze antibiotic prescribing trends and guideline concordance in outpatient settings using electronic health records (EHRs).
This quality improvement study utilized data from the Collaboration to Harmonize Antimicrobial Registry Measures (CHARM) database, which integrates antibiotic prescribing data extracted from the EHRs of various outpatient facilities.
The study was conducted across 352 outpatient facilities in the United States.
The study included oral antibiotic prescribing data from outpatient encounters from January 2021 to June 2023, encompassing 823,938 prescriptions.
The primary outcomes were the rate of antibiotic prescribing per 1 000 prescription-related outpatient visits and identifying frequently prescribed antibiotics in adults and children. Secondary outcomes were the prescribing patterns for selected diagnoses and the concordance of these prescriptions with published guidelines.
The study estimated approximately a 20% increase in antibiotic prescribing per year, with an overall rate of 121.26 prescriptions per 1 000 prescription-related outpatient visits (95% confidence interval 121.01-121.50). Amoxicillin-clavulanate, amoxicillin, doxycycline, and cephalexin were most frequently prescribed. Sinusitis and otitis media were the most common reasons for prescribing antibiotics among adults and children, respectively. Less than 60% of sinusitis-related prescriptions were antibiotic concordant. Duration concordance rates were less than 70% for sinusitis, urinary tract infections, cellulitis, and Group A Streptococci. 51% of ciprofloxacin prescriptions were for patients aged 60 or older.
The findings stress the need for strengthened antimicrobial stewardship in outpatient settings. The increasing rate of antibiotic prescriptions and discrepancies in guideline concordance reiterate the importance of ongoing monitoring and targeted interventions.
利用电子健康记录（EHRs）分析门诊环境中抗生素处方趋势及与指南的一致性。
这项质量改进研究利用了抗菌药物注册指标协调合作组织（CHARM）数据库的数据，该数据库整合了从各种门诊机构的电子健康记录中提取的抗生素处方数据。
该研究在美国的352家门诊机构中进行。
该研究纳入了2021年1月至2023年6月门诊就诊的口服抗生素处方数据，包括823,938张处方。
主要结果是每1000次与处方相关的门诊就诊的抗生素处方率，以及确定成人和儿童中常用的抗生素。次要结果是选定诊断的处方模式以及这些处方与已发表指南的一致性。
该研究估计每年抗生素处方量增加约20%，每1000次与处方相关的门诊就诊的总体处方率为121.26张（95%置信区间121.01 - 121.50）。阿莫西林克拉维酸、阿莫西林、多西环素和头孢氨苄是最常用的。鼻窦炎和中耳炎分别是成人和儿童中开具抗生素的最常见原因。与鼻窦炎相关的处方中，不到60%符合抗生素使用指南。鼻窦炎、尿路感染、蜂窝织炎和A组链球菌感染的疗程符合率低于70%。51%的环丙沙星处方是给60岁及以上患者的。
研究结果强调了在门诊环境中加强抗菌药物管理的必要性。抗生素处方率的上升以及与指南一致性的差异再次凸显了持续监测和针对性干预的重要性。
