Intended for healthcare professionals


Improving outpatient antibiotic prescribing

BMJ 2019; 364 doi: (Published 13 February 2019) Cite this as: BMJ 2019;364:l289

Linked Research

Effectiveness and safety of electronically delivered prescribing feedback and decision support on antibiotic use for respiratory illness in primary care

  1. Lauri A Hicks, director1,
  2. Laura M King, health research analyst1,
  3. Katherine E Fleming-Dutra, deputy director1
  1. 1Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-31 Atlanta, GA 30329, USA
  1. Correspondence to: L A Hicks auq3{at}

Harness the power of data

Outpatient prescriptions account for an estimated 85-95% of the volume of antibiotics used in people, and antibiotics are frequently overused and misused in outpatient settings.123 Optimizing antibiotic use in outpatient settings is increasingly recognized as an opportunity to improve patient safety.4 Two studies in The BMJ illustrate how to harness the power of outpatient antibiotic prescribing data to inform quality improvement.56 Data are critical to identify opportunities for improvement to inform action, track and report antibiotic use, and evaluate the impact of interventions.4

A first step to inform action is to assess the appropriateness of antibiotic prescribing. Chua and colleagues assigned antibiotic appropriateness categories—always, sometimes, or never—to 91 378 ICD-10-CM (international classification of diseases, 10th revision, clinical modification) codes, a commendable feat.5 They applied this scheme to a claims based dataset from a convenience sample of privately insured individuals under age 65 in the United States and found that 23% of antibiotic fills corresponded to visits with only “antibiotics never appropriate” diagnoses. …

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