Background: Inappropriate outpatient antibiotic prescribed in outpatient settings can lead to negative health outcomes, including antibiotic resistance. While previous studies show that outpatient antibiotic prescribing trends have not changed, few studies have shown whether these trends have changed after the COVID-19 pandemic.
Objectives: This study aimed to describe overall and inappropriate antibiotic prescribing trends in the United States (U.S.) over the last five years using a large, real world electronic medical record (EMR) network.
Methods: This was a retrospective study of all outpatient visits between 2020-2024 in the TriNetX Dataworks-USA Network, a large, federated, de-identified EMR network that includes standardized EMR data from 70 healthcare organizations and 117 million patients across the U.S. The study used the TriNetX Live Platform, and analyses were conducted on February 3, 2025. Antibiotic use was defined as at least one order or prescription of an antibiotic (RxNorm) during an outpatient visit. Diagnoses (ICD-10-CM or ICD-9) indicated or not indicated for antibiotic use were also assessed on the same day as the outpatient antibiotic record and were classified as appropriate, possibly appropriate, or inappropriate. The proportion of patients with an appropriate, possibly appropriate, and inappropriate antibiotic record out of total outpatient antibiotic records were assessed overall and annually between 2020-2024 and by age groups 0-17, 18-64, and 65+ years at the time of the visit.
Results: A total of 52.1 million patients had an outpatient visit; 15.8 million with an antibiotic. Among patients with an outpatient visit and diagnosis considered appropriate, possibly appropriate, and inappropriate, 55%, 45%, and 28% had an antibiotic record, respectively. Overall, outpatient trends remained relatively consistent, with 2023 having the highest proportion (23%). Highest rates of appropriate antibiotic use occurred in 2024 (49%), while 2022 saw the highest inappropriate antibiotic use rates (21%). 2022-2024 had similar rates of possibly appropriate use (41%). Patients aged 65 years and older saw the highest rates of antibiotic use (30%) among all age groups.
Conclusions: Many patients continue to be prescribed antibiotics during the COVID-19 pandemic, with one-third receiving antibiotics that may be inappropriate based on their indication. Older adults may be more likely to receive antibiotics when not clearly indicated. Trends of antibiotic use by year do not appear to change significantly between 2020-2024.
