Outpatient Antibiotic Use

Outpatient Antibiotic Use

Consumption is decreasing, but exhibiting substantial variation by drug class and region

Background

Antibiotics treat infections by killing or slowing down the growth of bacteria that cause disease. For the purpose of describing the development of bacterial resistance, the most convenient classification of antibiotics is the Anatomical Therapeutic Chemical (ATC) system, which groups drugs by their biochemical characteristics. Another classification is by their scope of action: narrow-spectrum antibacterials target specific species or classes, whereas broad-spectrum antibiotics are active against many different pathogen groups. This makes them a more attractive choice for empiric therapy – treating an unknown organism based on clinical presentation. However, since these drugs kill competing bacteria in addition to the targeted pathogen, the use of a broad-spectrum drug when a (usually cheaper) narrow-spectrum alternative would work carries an added cost in the form of increased resistance. 

Between 1999 and 2007 outpatient antibiotic consumption in the United States decreased by 12%, to 0.86 dispensed prescriptions per capita. By the same measure, use is likely lower than many southern European nations but also significantly higher than rates reported in Scandinavia and the Netherlands. Total antibiotic use follows a North-South and West-East gradient. Research has shown that beyond incidence of infectious diseases, a variety of unrelated socioeconomic and cultural factors can influence consumption, and thus there is substantial room to limit overuse in high-consumption areas.