Inappropriate antibiotic prescribing is common with or without a plausible antibiotic indication, and inappropriate prescribing is also common in U.S. emergency department visits, according to a study published online April 26 in the Journal of General Internal Medicine and a second study published May 14 in Antimicrobial Stewardship and Healthcare Epidemiology.

Joseph B. Ladines-Lim, M.D., Ph.D., from the University of Michigan in Ann Arbor, and colleagues examined the differences in inappropriate prescribing with or without a plausible indication between safety-net and non-safety-net populations. The analyses included 67,065,108 and 122,731,809 weighted visits for children and adults, respectively. The researchers found that the prevalence of inappropriate antibiotic prescribing was 11.7 and 22.0 percent, respectively, with a plausible indication among children in the safety-net and non-safety-net populations and 11.8 and 8.6 percent, respectively, without a plausible indication. For adults, the corresponding prevalence was 12.1 and 14.3 percent and 48.2 and 32.3 percent.

In a second study, Ladines-Lim and colleagues used national emergency department visit data from 2016 to 2021 to estimate the proportion of visits with inappropriate antibiotic prescribing. There were 819,395,799 weighted emergency department visits; 18.6 percent of these visits had one or more antibiotic prescription. The researchers found that 27.6 percent of the visits with antibiotic prescriptions had inappropriate prescribing, with 14.9 and 12.7 percent, respectively, with and without a plausible antibiotic indication. Of visits with inappropriate antibiotic prescribing, 54.0 and 46.0 percent had and did not have a plausible antibiotic indication, respectively.

“Emergency department antibiotic stewardship initiatives should focus both on reducing antibiotic prescribing for infectious, antibiotic-inappropriate conditions and on improving coding quality for antibiotic prescriptions,” write the authors of the second study.

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