Table 8

Evaluation of AHRQ's Pharmaceutical Outcomes Portfolio

Table 8: Level 1 Findings: Antibiotics and Antimicrobials

CERT	Population	Findings
Penn	Generalists and infectious disease specialists	Generalists and infectious disease specialists were found more likely to prefer newer drugs than older drugs when treating community-acquired pneumonia. Neither generalists nor specialists emphasized the relative societal risks of drug selection, but emphasized providing the newest and best treatments for each patient.
Penn	Nursing home residents	In the final model, prior fluoroquinolone use is a risk factor for the development of FQR-EC UTIs and absence of a urinary catheter is protective. Other studies found prior FQ use to be a risk factor for FQ resistance. None of these studies, however, focused on clinical urinary tract infection.
Penn	Patients with acne	S. pyogenes colonization and resistance in the oropharynx are associated with antibiotic therapy in patients with acne.
Penn	Patients with acne	Results from studying the General practice Research Database do support the notion that within the group of individuals who have acne and receive antibiotics [...] there is an increased association with a general practitioner office visit for upper respiratory tract infections/pharyngitis. This may be one of the first studies that has actually shown an increased rate of an infectious illness associated with long term antibiotic use in a generally healthy population.
Penn	General population	Preliminary analysis reveals that the proportion of the primary bloodstream infections accounted for by gram-negative pathogens has increased significantly over the past five years. These changes have great implications for empiric antimicrobial therapy for suspected bloodstream infections, but also for fostering the development of new agents with expanded gram-negative activity.
Penn	Pediatrics - Hospitalized children	Patients with ESBL-EK infection were 5/8 times more likely to have had exposure to an extended spectrum cephalosporin within the thirty days prior to infection and also were more likely to be female, had infection caused by a Klebsiella species, and received steroids in the thirty days prior to infection. Findings might be used to limit the emergence of ESBL-ED infections in children.
HMO	Pediatrics	Study results indicate that prescribing rates have decreased by 23% in children less than three years old from 1995-2000... The majority of the decrease in antibiotic use was because of a decreased rate of diagnosis of otitis media.
Penn	Physicians & Hospital decision-makers	Physicians are waiting until after prior-approval hours to order restricted antimicrobials. In addition, of those restricted antimicrobials ordered between 10 p.m. and 11 p.m., only 65% are actually continued.

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Page last reviewed December 2007

Internet Citation: Table 8: Evaluation of AHRQ's Pharmaceutical Outcomes Portfolio. December 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://archive.ahrq.gov/research/findings/final-reports/pharmportfolio/table8.html