HealthDay News — Large proportions of antibiotic prescriptions for Medicaid patients are filled without evidence of infection-related diagnoses or clinician visits, according to a report published in Health Affairs.

Michael A. Fischer, MD, from Harvard Medical School in Boston, and colleagues examined the frequency with which all filled antibiotic prescriptions for Medicaid patients were associated with infections and in-person visits in the period from 2004 to 2013.

The researchers found that 55, 17, and 28 percent of the 298 million antibiotic fills (62 percent for children) for 53 million patients were for clinician visits with an infection-related diagnosis, were for clinician visits without an infection-related diagnosis, and were not associated with a visit, respectively. Compared with adults, children less commonly had non-visit-based antibiotic prescriptions, which were more common in the West than in other U.S. regions.

“By failing to measure appropriate antibiotic prescribing, not including non-infection-related and non-visit-based prescribing, or focusing on narrow clinical scenarios, existing general and specific policies seem unlikely to improve antibiotic use on a large scale,” the authors write. “To improve public health, ambulatory antibiotic stewardship policies should include comprehensive measurement of antibiotic use and comprehensive measures of appropriateness.”


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