Trends in antimicrobial prescribing rates for Alaska native and American Indian persons

Abstract

Objectives. In the U.S., the total number of antimicrobials prescribed in ambulatory care declined between 1989 and 2000; however, antimicrobial resistance increased among many pathogens. We evaluated antimicrobial prescribing patterns from 1992 to 2004 in Alaska Native/American Indian (AI/AN) persons <18 years old, residing in the Anchorage region who received care through the AI/AN health system.Study design. Retrospective study based on medical records.Methods. Medical records were used to obtain data on oral antibiotics prescribed for ambulatory and emergency-room visits. Antimicrobial prescribing rates were calculated per population and per ambulatory-clinic visit.Results. The total number of antimicrobial courses prescribed increased 94% from 4,929 (1992) to 9,561 (2004). However, the total number of ambulatory-clinic visits also increased (79%) from 49,008 (1992) to 87,486 (2004), while the population of AI/AN persons <18 in Anchorage region rose 14%. The population-based rate of antimicrobial prescriptions (per 1,000 persons) rose from 309 (1992) to 524 (2004) (p<0.001). The visit-based annual rate (per 1,000 visits) remained stable from 101 (1992) to 109 (2004) (p=0.651). Overall, visit-based prescription rates in AI/AN persons were lower than previously reported among children in the U.S. (range 250–340). Penicillins comprised >50% of antimicrobials prescribed from 1992 to 2004. Visit-based prescribing rates from 1992 to 2004 changed: penicillin, +27% (p=0.210); cephalosporins, +33% (p=0.023); trimethoprim-sulfamethexazole, −48% (p<0.001).Conclusions. Visit-based antimicrobial prescribing rates in the Anchorage region for AI/AN children receiving care in the AI/AN health system have been stable over a 13-year period. Although a trend in decreased antibiotic prescribing has been seen in the general U.S. population, visit-based prescribing rates in the Anchorage region for AI/AN children have remained below those in previous studies in the U.S.