Cross-sectional studycited by the Tayebat archiveabstract only checked★ key study A-ABX-19 in-depth review
Unnecessary antibiotic prescriptions in the US
Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011.
Overview
Fleming-Dutra KE et al.. JAMA 2016 · PMID 27139059 · DOI 10.1001/jama.2016.4151
About 30% of outpatient antibiotic prescriptions were judged unnecessary.
Does the study support the specific claim? Yes · Methodological quality: high
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Estimate inappropriate use.
- How was the study done?
Survey analysis.
- How many people, animals or samples were studied?
184,032 visits.
- What was actually found?
30% inappropriate.
- How large was the observed effect?
506 vs 353/1000.
- What do the results mean in everyday life?
Overuse is common.
- What are the study's limitations?
Estimated appropriateness.
- What does it say about Elawady's specific claim?
Supports.
- Do the results apply to Germany and Europe?
Low.
- What can explicitly not be concluded from this study?
That antibiotics are never needed.
Scientific in-depth review
1. Full reference
- Authors
- Fleming-Dutra KE, Hersh AL, Shapiro DJ, Bartoces M, Enns EA, File TM, Finkelstein JA, Gerber JS, Hyun DY, Linder JA, Lynfield R, Margolis DJ, May LS, Merenstein D, Metlay JP, Newland JG, Piccirillo JF, Roberts RM, Sanchez GV, Suda KJ, Thomas A, Woo TM, Zetts RM, Hicks LA
- Journal
- JAMA
- Year
- 2016
- Identifier
- PMID 27139059 DOI 10.1001/jama.2016.4151
- Verification
- verified – PubMed E-utilities efetch, 2026-10-25
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
not stated in abstract/record
2. Research question
How much outpatient antibiotic prescribing is inappropriate in the US?
3. Study design and population
- Study design
- Cross-sectional study – Cross-sectional analysis of national ambulatory care surveys
- Population
US ambulatory visits
- Country
USA
- Period
2010-2011
- Sample size
184,032 sampled visits
- Inclusion and exclusion criteria
NAMCS/NHAMCS
4. Methods and endpoints
- Exposure / intervention
Visits
- Comparator
Guideline-based appropriate rates
- Endpoints
Antibiotic prescriptions per 1000
- Statistical methods
Survey-weighted estimates
5. Actual results
- Results
12.6% of visits with antibiotic; 506 Rx/1000/year, 353 appropriate; acute respiratory 221 Rx/1000, 111 appropriate.
- Absolute risks
506 vs 353 per 1000 population per year.
- Authors' conclusion
Supports goal for outpatient stewardship.
6. Strengths
- National data
7. Weaknesses
- Appropriateness estimated, not chart-reviewed
8. Risk of bias
- Orienting tool
- none applicable
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
9. Assessment of the statistical interpretation
10. Relevance to the specific claim
11. Independent contrary findings
12. Transferability to Germany and Europe
Low (US).
13. Overall methodological judgement
Robust.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | high |
| Risk of bias | some concerns |
| Precision of results | high |
| Directness | direct |
| Reproducibility | partly replicated |
| Consistency with the overall evidence | consistent |
| Regional transferability | low |
| Adequacy of the interpretation (by the archive) | essentially correct but incomplete |
14. Open questions
15. Linked fact checks
- About 30% of US outpatient antibiotic prescriptions (2010-2011) were unnecessary - about 47 million prescriptions a year, mostly for viral infections. – Studies supporting the claim
- Antibiotics should not be used as a treatment at all; nobody should take an antibiotic for any reason (not even after a tooth extraction); the body can cope on its own. – Studies supporting the claim
Use by the Tayebat archive
Note: according to the archive, the studies were compiled by the archive operators. Whether Dr. Elawady himself cited this study is not established.
- What the archive says about the study
About 30% of US outpatient antibiotic prescriptions in 2010-2011 were inappropriate, mostly for viral respiratory infections; narrative: ~47 million per year.
- A. What was actually studied?
Inappropriate prescribing.
- B. What did the authors find?
506 vs 353 per 1000.
- C. What conclusions do the authors themselves draw?
Stewardship needed.
- D. What does the archive derive from it?
'47 million handed out for viral infections'.
- E. Is this derivation scientifically justified?
30% correct; 47 million not in abstract (not verified); not all excess was for viral infections.
- Adequacy of the interpretation (by the archive)
- essentially correct but incomplete