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Antibiotic prescribing patterns vary by specialty.

NICE, FRANCE -- Family practitioners prescribe penicillins most often, whereas ob.gyns. prescribe nitrofurans more frequently than any other specialty.

These are some of the findings from a 3-year study examining prescribing patterns of oral antibiotics by physician specialty in the United States.

This is the first study to offer a national perspective on outpatient antimicrobial prescribing by physician specialty, Katie J. Suda, Pharm.D., and her associates reported at the 16th European Congress of Clinical Microbiology and Infectious Diseases.

"Over the 3 years, prescribing patterns did vary significantly by physician specialty," she said.

Investigators evaluated outpatient antibiotic prescriptions dispensed in 2001-2003 from nine managed health care plans. Medications were stratified into classes and formulations as defined by the American Hospital Formulary Service.

Diagnostic codes were defined according to Medicode (now referred to as Ingenix).

A total of 7,613 physicians wrote 48,182 antibiotic prescriptions for 26,875 patients. The average patient age was 34 years.

The majority of patients were diagnosed with upper respiratory tract infection; the next most frequent diagnoses were sinusitis and genitourinary infections.

Physician specialties included family practice (42%), internal medicine (14%), pediatrics (21%), emergency medicine (5%), specialists (5%), dermatologists (4%), obstetricians/gynecologists (3%), surgeons (3%), and others such as pathologists and psychiatrists (3%).

Overall, penicillins were the antibiotics dispensed most frequently, followed by macrolides, cephalosporins, and fluoroquinolones, said Dr. Suda of the University of Tennessee Health Science Center in Memphis.

Dermatologists most often prescribed tetracyclines (75%); emergency medicine physicians, macrolides (42%); ob.gyns., nitrofurans (27%); pediatricians, penicillins (38%); and surgeons, fluoroquinolones (25%). Family practitioners prescribed penicillins most often, while internists prescribed fluoroquinolones.

Internists prescribed broader-spectrum agents for the treatment of urinary tract infections, whereas ob.gyns. prescribed narrower-spectrum agents, even though not all of their patients may be pregnant or lactating, she said. Fluoroquinolones were used most often for UTIs by family practitioners, internists, and emergency physicians, and nitrofurans by ob.gyns. and surgeons.

All physician groups prescribed [beta]-lactamase inhibitors more frequently than any other agent for the treatment of skin and skin structure infections.

[beta]-lactamase inhibitors were the treatment of choice for upper respiratory tract infections for family practitioners and specialists. But internists and emergency physicians were more likely to prescribe macrolides, which may be because these physicians see more patients with complicated conditions, she said. Pediatricians used penicillins most often, followed by macrolides and [beta]-lactamase inhibitors.

Overall, lower respiratory tract infections were treated most often with macrolides, followed by fluoroquinolones.

Audience members questioned whether the findings were representative of family care in the United States, particularly in light of the high fluoroquinolone use that was reported. Dr. Suda said she believed the findings were representative of a managed care population under the age of 65 years, but added that she was unable to validate the findings against data from other plans because most organizations won't release the information.

The most commonly prescribed fluoroquinolones were levofloxacin (more than 50% of prescriptions), followed by ciprofloxacin, moxifloxacin, and gatifloxacin, according to Dr. Suda.


Chicago Bureau
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Title Annotation:Clinical Rounds
Author:Wendling, Patrice
Publication:OB GYN News
Date:Jul 1, 2006
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