Antibiotic Use in the United States

At a glance

  • CDC monitors antibiotic use in outpatient, acute, and long-term care settings.
  • Antibiotics are commonly prescribed unnecessarily in different healthcare settings.
  • Measuring and evaluating antibiotic use across healthcare settings helps ensure that antibiotics are prescribed appropriately.

Overview

  • The National Action Plan for Combating Antibiotic Resistant Bacteria (CARB) is a coordinated, strategic plan to address antimicrobial resistance that guides CDC's antimicrobial resistance investments and activities. CARB includes national goals to improve antibiotic use.
  • CDC uses different surveillance systems, data sources, and metrics to measure and report antibiotic use in outpatient, acute care, and long-term care settings.
  • Antibiotic use surveillance data can be used by healthcare facilities to prioritize antibiotic stewardship strategies.

Outpatient settings

Prescribing trends

  • Most human antibiotic use (85-95%) occurs in outpatient settings. 1
  • At least 28% of antibiotics prescribed in outpatient settings are considered unnecessary.2
    • There are also opportunities to improve selection, dosing, and duration of antibiotics prescribed.

Antibiotic use surveillance data sources

  • Outpatient pharmacy dispensing data are used to track the number and rates of oral antibiotics dispensed in U.S. community pharmacies.3
  • Outpatient administrative claims data are submitted by healthcare organizations to receive reimbursement from health payers for services provided and can be used to assess appropriateness of antibiotics prescribed for specific diagnoses4.
    • measures examine the quality of antibiotic prescribing by region and across health plans. These data are reported by healthcare insurance organizations and can be used to improve antibiotic prescribing. There are four HEDIS measures related to antibiotic use: 1) , 2) , 3) , and 4)
  • Electronic health record data capture details of patient encounters and can be used for antibiotic use surveillance.5

Antibiotic prescribing reports

Outpatient pharmacy dispensing data provide outpatient antibiotic prescription volumes by year, age, sex, state, antibiotic class, and provider specialty. View outpatient antibiotic prescription data on CDC's .

Acute care hospitals

Prescribing trends

About 30% of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or suboptimal.6

Antibiotic use surveillance data sources

Long-term care settings

Prescribing trends

Approximately 50% of long-term care facility residents will be prescribed an antibiotic annually.910

Antibiotic use surveillance data sources

  • Long-term care pharmacies contract specialized services to long-term care facilities, including dispensing and delivery of medications. Pharmacy transactions can be used to report antibiotic use at the facility level.9
  • Electronic health record data capture medication orders or administration and can be used to assess antibiotic use and inform stewardship efforts.10
  • Nursing home surveys gather data on healthcare-associated infection and antibiotic use among residents in long-term care facilities.11

Terms to know

Appropriate antibiotic prescribing

  • Antibiotics are prescribed when needed: the right antibiotic is selected at the right dose and for the right duration.
  • Antibiotics are prescribed in accordance with national and local guidelines and recommendations.

Inappropriate antibiotic prescribing

Inappropriate prescribing includes:

  • Unnecessary use of antibiotics for diagnoses that do not require an antibiotic (e.g., bronchitis) or duplicate treatment (e.g., dual anaerobic coverage).
  • Suboptimal antibiotic selection, dose, or treatment duration.

Antibiotic use metrics and quality measures12

  • Antibiotic use metrics can assess antibiotic use by reporting the volume or appropriateness of prescriptions.
  • An antibiotic use quality measure is a standardized method for assessing appropriateness of antibiotic use and can be used to compare performance across health plans, facilities, or healthcare professionals to ensure that antibiotics are prescribed appropriately.
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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)
  1. Duffy E, Ritchie S, Metcalfe S, Van Bakel B, Thomas MG. . J Clin Pharm Ther. 2018 Feb;43(1):59-64.
  2. Hersh AL, King LM, Shapiro DJ, Hicks LA, Fleming-Dutra KE. . Clin Infect Dis. 2021;72(1):133-137.
  4. King LM, Tsay SV, Hicks LA, Bizune D, Hersh AL, Fleming-Dutra K. Antimicrob Steward Healthc Epidemiol. 2021 Dec 17;1(1):1-8.
  5. McIsaac WJ, Kukan S. . J Prim Care Community Health. 2023 Jan-Dec;14:21501319231210616.
  6. Fridkin S, Baggs J, Fagan R, et al. Mar 7 2014;63(9):194-200.
  7. Magill SS, O'Leary E, Ray SM, et al. Clin Infect Dis. 2021;72(10):1784-1792.
  8. Rose AN, Baggs J, Wolford H, Neuhauser MM, Srinivasan A, Gundlapalli AV, Reddy S, Kompaniyets L, Pennington AF, Grigg C, Kabbani S. Open Forum Infect Dis. 2021 Jun 3;8(6):ofab236.
  9. Gouin KA, Creasy S, Beckerson M, Wdowicki M, Hicks LA, Kabbani S. . Antimicrob Steward Healthc Epidemiol. 2024;4(1):e209. Published 2024 Nov 21.
  10. Kabbani S, Wang SW, Ditz LL, et al. . Antimicrob Steward Healthc Epidemiol. 2021;1(1):e58. Published 2021 Dec 7
  11. Thompson ND, Stone ND, Brown CJ, et al. . JAMA 2021;325:1286–1295.
  12. CHCS. Center for Health Care Strategies (2020).
  • Arena CJ, Veve MP, Fried ST, Ware F, Lee P, Shallal AB. Antimicrob Steward Healthc Epidemiol. 2024 Dec 13;4(1):e217.