Executive Summary
The overuse of antibiotics, which is known to cause antibiotic-resistant bacteria, has been a topic of concern among healthcare professionals and policy makers in America for many years.1 In particular, the use of broad-spectrum antibiotics to treat a wide range of bacteria has been found to create antibiotic-resistant strains of bacteria. These resistant bacteria are immune to common medications and are difficult to treat.
Since 2010, antibiotic prescription rates in the U.S. have been declining among the commercially insured population, falling 9 percent during this period. This decline indicates that considerable progress is being made in public health campaigns to limit the use of antibiotics and prevent the development of antibiotic-resistant bacteria.
The Analysis
In this report, the Blue Cross Blue Shield Association, in partnership with HealthCore and Blue Health Intelligence, examine antibiotic prescriptions filled by commercially insured members from 2010 to 2016 as a result of an outpatient visit. Antibiotics administered as part of an inpatient visit were not included in this study. The scope of the research included 173 million patient claims for filled antibiotic prescriptions from over 31 million commercially insured Americans under age 65. This report includes antibiotics that were prescribed to and filled by a patient (referred to here as the antibiotic prescription fill rate), and are thereby considered as antibiotics used to treat a patient’s condition.
Summary of Key Findings
The fill rate of outpatient antibiotic prescriptions declined 9 percent among commercially insured Americans from 2010 to 2016.
Broad-spectrum antibiotic fill rates dropped the most at 13 percent. Broad-spectrum antibiotics are the type most likely to facilitate the creation of antibiotic-resistant bacteria. (See below for a description of each type of antibiotic discussed in this report.)
The drop in antibiotic fill rates was significantly greater in children (16 percent) when compared to adults (6 percent), with infants experiencing the steepest decline (22 percent).
Wide regional variation in antibiotic prescription fill rates exists, with the highest-prescribing states filling nearly three times as many prescriptions per person as the lowest-prescribing states.
Portions of Appalachia and the South have the highest prescription fill rates.
Prescription fill rates in rural areas are 16 percent higher than in urban areas.
While progress has been made, further improvements surrounding antibiotic prescriptions are warranted. In 2016, healthcare professionals prescribed antibiotics in more than 20 percent of outpatient visits where their use is not indicated to treat the condition.3 Broad-spectrum antibiotics are used in the majority of these cases.
Antibiotic Types
This research looks at four categories of antibiotics across age, gender, geography and setting of care.
Broad-spectrum antibiotics cover a wide range of bacteria and are commonly used when the particular bacteria is unknown. Use of these antibiotics prevents the need to culture bacteria and wait for the results. Because broad-spectrum antibiotics treat a wide range of bacteria, their use is more likely to lead to antibiotic resistance. Examples include azithromycin (including Z-Pak), cefaclor and fluoroquinolones. Broad-spectrum antibiotics are generally recommended to be a backup treatment option or avoided in most common infections.
Intermediate-spectrum antibiotics cover fewer types of bacteria than broad-spectrum antibiotics and are considered the initial recommended treatment for some conditions. Examples include amoxicillin, erythromycin and tetracyclines. Intermediate-spectrum antibiotics are often considered drugs of choice for uncomplicated ear and throat infections caused by several different types of bacteria.
Narrow-spectrum antibiotics are used to treat a narrow range of bacteria and are considered the best initial recommended treatment for specific conditions. Examples include penicillin G and first-generation cephalosporins. Narrow-spectrum antibiotics are typically only effective against bacteria that have not developed resistance, which may include conditions such as uncomplicated skin or urinary tract infections.
Reserved antibiotics are narrow-spectrum, but are not considered the initial recommended treatment for some conditions. Reserved antibiotics should only be used for bacteria that have developed resistance to other antibiotics, such as resistant skin infections caused by MRSA (methicillin-resistant staphylococcus aureus). Examples include vancomycin, linezolid and aztreonam.