P-1647. Prevalence of Unnecessary Antibiotic Prescribing for Acute Respiratory Illnesses in U.S. Outpatient Settings, 2022

Abstract Background Antibiotics are commonly prescribed for acute respiratory illnesses (ARIs) in outpatient settings, yet up to 50% of antibiotics prescribed for ARIs are unnecessary. We aimed to estimate the prevalence of outpatient antibiotic prescribing for ARIs with no clinical indication for antibiotics (“No Antibiotics Indicated ARIs” or “NAI-ARIs”) and compare it to previously published estimates. Methods Patients ages 0–64 years and ≥ 65 years with medical and prescription drug coverage were identified from Merative MarketScan commercial claims and Medicare Part B claims and Part D event files, respectively. We included outpatient visits in 2022 associated with a NAI-ARI diagnosis of asthma/allergy, bronchitis/bronchiolitis, COVID-19, influenza, non-suppurative otitis media, respiratory syncytial virus (RSV) or viral upper respiratory infection (URI). We calculated the visit rate per 1,000 patient-years and proportion of visits resulting in an oral antibiotic for each diagnosis stratified by age group and outpatient setting. The proportion of unnecessary prescribing for individuals ages < 65 years was compared to published proportions from 2011 and 2018; no comparable prior estimates are available for adults ages ≥ 65 years. Results The proportion of NAI-ARI visits resulting in an antibiotic was 18% for adults ages ≥ 65 years, 11% for adults ages 20–64 years, and 8% for children ages 0–19 years. The overall proportion of prescribing for individuals ages < 65 years was lower in 2022 compared to both 2011 and 2018 (Figure 1). Across all age groups, bronchitis/bronchiolitis had the highest proportion of visits with an antibiotic, while viral URI had the highest rate of visits with an antibiotic (Table 1). Urgent care settings had the highest proportion of visits with an antibiotic across outpatient settings, irrespective of age (Figure 2 and Figure 3). Conclusion Among patients ages < 65 years, the proportion of unnecessary antibiotic prescribing for NAI-ARIs declined over the past decade, possibly due to antibiotic stewardship activities. Continued efforts to improve outpatient antibiotic use should focus on viral URI, bronchitis/bronchiolitis, and emphasize reducing unnecessary prescribing in older adults and urgent care settings. Disclosures All Authors: No reported disclosures