At a glance
- Healthcare professionals, health systems and public health professionals monitor outpatient antibiotic prescribing to characterize trends, improve prescribing and measure progress.
- By measuring prescription volume, prescribing rates and appropriateness, we can compare performance across regions, states and other entities.
- Healthcare professionals, health systems and public health professionals can use quality measures to determine if prescribing patterns meet appropriate outpatient antibiotic prescribing standards.
- National goals help drive change and optimize prescribing practices.
Current report
Spotlight
View outpatient antibiotic prescription data from IQVIA Xponent® data and U.S. Census files in an interactive database, CDC's Antimicrobial Resistance & Patient Safety Portal.
Key U.S. statistics
Did you know?
At least 28% of antibiotics prescribed in outpatient settings are not needed.2
Below are statistics that describe how antibiotics are currently prescribed in outpatient settings in the United States and how these practices contribute to antimicrobial resistance.
- The majority (>60%) of antibiotic costs are associated with outpatient settings.1
- An estimated 80-90% of human antibiotic use occurs in outpatient settings23.
- In 2022, healthcare providers prescribed 236.4 million antibiotic prescriptions dispensed from U.S. community pharmacies, roughly 7 prescriptions for every 10 people in the outpatient setting4.
- At least 28% of antibiotics prescriptions are unnecessary in U.S doctor's offices and emergency departments5. There are opportunities to improve inappropriate selection, dosing and duration678.
- Azithromycin and amoxicillin are the most prescribed antibiotics4.
- Antibiotic prescribing rate in outpatient settings varies by state4.
- Performance on quality measures for appropriate outpatient antibiotic prescribing varies by both region and type of commercial health plan9. Healthcare payers can play a unique role in improving outpatient antibiotic use10.
- Local outpatient prescribing practices may contribute to local antimicrobial resistance patterns11. Strategies to reduce antimicrobial resistance should include improving antibiotic use.
Data sources
- Proprietary datasets from third party vendors like the IQVIA database measure the number and rates of outpatient, oral antibiotics dispensed in U.S. community pharmacies. Antibiotics are classified into antibiotic classes based on mechanisms of action using IQVIA's Uniform System of Classification.
- Quality measure data like the Healthcare Effectiveness Data and Information Set (HEDIS) examine the quality of antibiotic prescribing by region and across health plans. CDC helped write three HEDIS measures: utilization for respiratory conditions, avoidance of antibiotic treatment for bronchitis and treatment for upper respiratory infections.
- CDC's National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) measures outpatient antibiotic prescribing and appropriateness in U.S. office-based physicians' offices, emergency departments and hospital-based clinics. Claims data are also used to characterize outpatient antibiotic prescribing and appropriateness.
- Appropriate antibiotic prescribing means:
- Antibiotics are prescribed when needed: the right antibiotic is selected and prescribed at the right dose and for the right duration.
- Antibiotic prescribing should be in accordance with evidence-based national and local clinical practice guidelines.
- Antibiotics are prescribed when needed: the right antibiotic is selected and prescribed at the right dose and for the right duration.
- Inappropriate antibiotic prescribing includes:
- Unnecessary prescribing of antibiotics.
- Wrong antibiotic prescription (improper selection).
- Incorrect dose.
- Wrong duration.
- Unnecessary prescribing of antibiotics.
CDC reports on antibiotic use and prescribing
- IQVIA Xponent® antibiotic prescription data provides outpatient antibiotic prescription volumes by year, age, sex, region, antibiotic agent and class and provider specialty.
- CDC calculates yearly antibiotic prescription rates per 1,000 persons by age, sex and region using annual U.S. Census files.
- Healthcare provider specialties are based on the American Medical Association (AMA) self-designated practice specialties, Drug Enforcement Administration (DEA) and National Provider Identifier (NPI) sources and categorized into one of 17 specialties.
- Provider specialty denominators are estimated by extracting the total number of providers in each provider specialty from the IQVIA Xponent® prescription database.
- CDC calculates antibiotic prescription rates by provider specialty using provider denominators aggregated by IQVIA.
- The calculated rates of antibiotic prescriptions by provider specialty in 2011-2021 used the 2011 provider specialty denominators.
- Changes in healthcare workforce numbers were not reflected in the denominators from 2012-2021.
- In 2022, the calculated provider specialty antibiotic prescription rates used the concurrent 2022 provider specialty denominators.
- The calculated rates of antibiotic prescriptions by provider specialty in 2011-2021 used the 2011 provider specialty denominators.
National goals
The 2020-2025 National Action Plan for Combating Antibiotic-Resistant Bacteria (CARB) aims to lower the annual rate of outpatient dispensing per 1,000 U.S. population among specified subpopulations.
- Suda KJ, Hicks LA, Roberts RM, Hunkler RJ, Danziger LH. A national evaluation of antibiotic expenditures by healthcare setting in the United States, 2009. J Antimicrob Chemother. 2013;68:715-8
- Public Health England. English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR): report 2014 [Internet]. London, England: Public Health England; 2014. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/362374/ESPAUR_Report_2014__3_.pdf [PDF – 4.35 MB]
- Public Health Agency of Sweden, National Veterinary Institute. Consumption of antibiotics and occurrence of antibiotic resistance in Sweden [Internet]. Swedres-Svarm 2014. Solna and Uppsala, Sweden: Public Health Agency of Sweden, National Veterinary Institute; 2015. Report No.: ISSN 1650–6332. https://www.folkhalsomyndigheten.se/pagefiles/20281/Swedres-Svarm-2014-14027.pdf [PDF -4.9 MB]
- Centers for Disease Control and Prevention. Outpatient antibiotic prescriptions — United States, 2022. Available via the internet: https://www.cdc.gov/antibiotic-use/data/report-2022.html
- Hersh AL, King LM, Shapiro DJ, Hicks LA, Fleming-Dutra KE. Unnecessary Antibiotic Prescribing in US Ambulatory Care Settings, 2010-2015. Clin Infect Dis. 2021;72(1):133-137.
- Centers for Disease Control and Prevention (CDC). Office-related antibiotic prescribing for persons aged ≤14 years — United States, 1993—1994 to 2007—2008. MMWR Morb Mortal Wkly Rep. 2011;60(34):1153-6.
- Pichichero ME. Dynamics of antibiotic prescribing for children. JAMA. June 19, 2002;287(23):3133-5.
- Shapiro DJ, Hicks LA, Pavia AT, Hersh AL. Antibiotic prescribing for adults in ambulatory care in the USA, 2007–09. J Antimicrob Chemother. 2014;69(1):234-40.
- Roberts, R., et al. (2016). "Variation in US outpatient antibiotic prescribing quality measures according to health plan and geography." The American journal of managed care 22(8): 519-523.
- Centers for Disease Control and Prevention. Improving Outpatient Antibiotic Prescribing. A Toolkit for Healthcare Payers. Atlanta, GA: US Department of Health and Human Services, CDC; 2021.
- Hicks LA, Chien YW, Taylor TH Jr, Haber M, Klugman KP; Active Bacterial Core surveillance (ABCs) Team. Outpatient antibiotic prescribing and nonsusceptible Streptococcus pneumoniae in the United States, 1996-2003. Clin Infect Dis. 2011;53(7):631-9.
- Suda KJ, Hicks LA, Roberts RM, Hunkler RJ, Taylor TH. Trends and seasonal variation in outpatient antibiotic prescription rates in the United States, 2006 to 2010. Antimicrob Agents Chemother. 2014;58(5):2763-6.