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Antibiotics Are Often Prescribed Without Documented Indication

December 13, 2019

An estimated 24 million antibiotic prescriptions lacked documented indication in 2015, according to the results of a recent study.

While previous programs used to evaluate antibiotic use have depended on the presence of a documented indication within medical records, a lack of this information (which is not universally required) could lead to underestimates of inappropriate antibiotic prescribing, according to the study authors.

In order to examine the frequency at which antibiotics are prescribed without indication and how this could affect estimates of appropriate prescribing, the researchers conducted a cross sectional study using data from 28,332 sample visits representing 990.0 million ambulatory care visits from the 2015 National Ambulatory Medical Care Survey.

Overall, they found that antibiotics were prescribed during 13.2% (95% confidence interval 11.6% to 13.7%) of the 990.8 million ambulatory care visits in 2015. According to their criteria, 57% (52% to 62%) of the 130.5 million prescriptions had appropriate indications, 25% (21% to 29%) had inappropriate indications, and 18% (15% to 22%) had no documented indication.

Factors that were significantly associated with a higher likelihood of being prescribed antibiotics without a documented indication included being an adult male, having at least one chronic disease spending more time with the provider, and seeing non-primary care specialists. Sulfonamides and urinary anti-infective agents were the most likely classes to be prescribed without documented indication.

“This nationally representative study of ambulatory visits identified a large number of prescriptions for antibiotics without a documented indication. Antibiotic prescribing in the absence of a documented indication may severely bias national estimates of appropriate antibiotic use in this setting. This study identified a wide range of factors associated with antibiotic prescribing without a documented indication, which may be useful in directing initiatives aimed at supporting better documentation,” the authors concluded.

—Michael Potts


Ray MJ, Tallman GB, Bearden DT, Elman MR, McGregor JC. Antibiotic prescribing without documented indication in ambulatory care clinics: national cross sectional study [published online December 11, 2019]. BMJ. 2019;367:l6461. doi:

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