Inappropriate ceftriaxone use in outpatient acute respiratory infection management

• Published in: Infection control and hospital epidemiology 2019-04, Vol.40 (4), p.487-490
• Main Authors: King, Laura M, Talley, Pamela, Kainer, Marion A, Evans, Christopher D, Adre, Cullen, Hicks, Lauri A, Fleming-Dutra, Katherine E
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Ambulatory Care Facilities; Anti-Bacterial Agents - therapeutic use; Antibiotics; Bacterial diseases; Bacterial infections; Binomial distribution; Bronchitis; Ceftriaxone - therapeutic use; Disease transmission; Drug Utilization; Employers; Female; Humans; Infections; Infectious diseases; Influenza; Male; Middle Aged; Nursing; Outpatients; Prescription Drug Misuse - statistics & numerical data; Respiratory Tract Infections - drug therapy; Sexually transmitted diseases; Sinusitis; Software; STD; United States; Young Adult
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2019.21

Ceftriaxone, a parenteral third-generation cephalosporin, is used to treat serious bacterial infections and sexually transmitted diseases.1 Inappropriate ceftriaxone use contributes to resistance to this important antibiotic and threatens patient safety due to antibiotic-associated adverse events and Clostridioides difficile infections.2 Previous studies of inappropriate antibiotic prescribing in outpatient acute respiratory infections (ARIs) have focused on oral, rather than parenteral, antibiotics.3,4 Our objective was to describe ceftriaxone use in adult outpatient ARI visits. The National Center for Emerging and Zoonotic Infectious Diseases human subjects advisor determined this study to be nonhuman subjects research not requiring institutional review board review. Ceftriaxone-Inappropriate ARI Visits (%)f Per-Visit Ceftriaxone Rateg (95% CI)h All 2,033,806 (100.0) 0.2 (0.2–0.2) 1,804,047 (100.0) 1.3 (1.3–1.3) 4,110,467 (100.0) 6.9 (6.9–7.0) 1,438,808 (100.0) 1.5 (1.5–1.5) 9,653,688 (100.0) 3.5 (3.5–3.5) Sex Male 754,021 (37.1) 0.2 (0.2–0.2) 656,460 (36.4) 1.5 (1.4–1.5) 1,445,878 (35.2) 7.5 (7.5–7.6) 541,018 (37.6) 1.7 (1.6–1.7) 3,487,718 (36.1) 3.7 (3.7–3.8) Female 1,279,785 (62.9) 0.1 (0.1–0.1) 1,147,587 (63.6) 1.2 (1.2–1.3) 2,664,589 (64.8) 6.6 (6.6–6.6) 897,790 (62.4) 1.4 (1.4–1.5) 6,165,970 (63.9) 3.4 (3.4–3.4) Age group, y 18–34 612,342 (30.1) 0.2 (0.2–0.2) 581,619 (32.2) 1.0 (1.0–1.0) 1,267,629 (30.8) 5.9 (5.8–5.9) 462,716 (32.2) 1.5 (1.5–1.5) 3,006,303 (31.1) 3.0 (2.9–3.0) 35–44 451,603 (22.2) 0.1 (0.1–0.2) 406,192 (22.5) 1.2 (1.2–1.3) 956,949 (23.3) 7.0 (7.0–7.1) 331,550 (23.0) 1.5 (1.4–1.5) 2,206,650 (22.9) 3.6 (3.5–3.6) 45–54 501,090 (24.6) 0.1 (0.1–0.2) 418,606 (23.2) 1.5 (1.5–1.6) 981,305 (23.9) 7.6 (7.6–7.7) 333,775 (23.2) 1.6 (1.5–1.6) 2,299,088 (23.8) 3.8 (3.8–3.9) 55–64i 468,771 (23.0) 0.2 (0.1–0.2) 397,630 (22.0) 1.7 (1.6–1.7) 904,584 (22.0) 7.6 (7.5–7.6) 310,767 (21.6) 1.5 (1.5–1.6) 2,141,647 (22.2) 3.8 (3.8–3.9) Outpatient setting Physician office 1,810,730 (89.0) 0.2 (0.2–0.2) 1,655,052 (91.7) 1.3 (1.3–1.3) 3,626,023 (88.2) 7.3 (7.3–7.3) 1,243,563 (86.4) 1.4 (1.3–1.4) 8,577,226 (88.8) 3.6 (3.6–3.6) Retail health 1,858 (0.1) 0.0 (0.0–0.0) 11,049 (0.6) 0.0 (0.0–0.0) 11,909 (0.3) 0.9 (0.8–1.1) 2,113 (0.1) 0.0 (0.0–0.0) 26,934 (0.3) 0.4 (0.3–0.5) Urgent care 221,218 (10.9) 0.1 (0.1–0.2) 137,946 (7.6) 1.5 (1.5–1.6) 472,535 (11.5) 4.5 (4.4–4.5) 193,132 (13.4) 2.6 (2.5–2.7) 1,049,528 (10.9) 2.7 (2.7–2.8) Diagnosis Sinusitis 821,657 (40.4)