{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T17:13:29Z","timestamp":1779210809080,"version":"3.51.4"},"reference-count":40,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T00:00:00Z","timestamp":1710979200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U54CK000609"],"award-info":[{"award-number":["U54CK000609"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000133","name":"Agency for Healthcare Research and Quality","doi-asserted-by":"publisher","award":["R24 HS19455"],"award-info":[{"award-number":["R24 HS19455"]}],"id":[{"id":"10.13039\/100000133","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pharmacoepidemiology and Drug"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Purpose<\/jats:title><jats:p>To characterize antibiotic utilization for outpatient community\u2010acquired pneumonia (CAP) in the United States.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a cohort study among adults 18\u201364\u2009years diagnosed with outpatient CAP and a same\u2010day guideline\u2010recommended oral antibiotic fill in the MarketScan\u00ae Commercial Database (2008\u20132019). We excluded patients coded for chronic lung disease or immunosuppressive disease; recent hospitalization or frequent healthcare exposure (e.g., home wound care, patients with cancer); recent antibiotics; or recent infection. We characterized utilization of broad\u2010spectrum antibiotics (respiratory fluoroquinolone, \u03b2\u2010lactam + macrolide, \u03b2\u2010lactam + doxycycline) versus narrow\u2010spectrum antibiotics (macrolide, doxycycline) overall and by patient\u2010 and provider\u2010level characteristics. Per 2007 IDSA\/ATS guidelines, we stratified analyses by otherwise healthy patients and patients with comorbidities (coded for diabetes; chronic heart, liver, or renal disease; etc.).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 263\u2009914 otherwise healthy CAP patients, 35% received broad\u2010spectrum antibiotics (not recommended); among 37\u2009161 CAP patients with comorbidities, 44% received broad\u2010spectrum antibiotics (recommended). Ten\u2010day antibiotic treatment durations were the most common for all antibiotic classes except macrolides. From 2008 to 2019, broad\u2010spectrum antibiotic use substantially decreased from 45% to 19% in otherwise healthy patients (average annual percentage change [AAPC], \u22127.5% [95% CI \u22129.2%, \u22125.9%]), and from 55% to 29% in patients with comorbidities (AAPC, \u22125.8% [95% CI \u22128.8%, \u22122.6%]). In subgroup analyses, broad\u2010spectrum antibiotic use varied by age, geographic region, provider specialty, and provider location.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Real\u2010world use of broad\u2010spectrum antibiotics for outpatient CAP declined over time but remained common, irrespective of comorbidity status. Prolonged duration of therapy was common. Antimicrobial stewardship is needed to aid selection according to comorbidity status and to promote shorter courses.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.5779","type":"journal-article","created":{"date-parts":[[2024,3,21]],"date-time":"2024-03-21T08:04:33Z","timestamp":1711008273000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Utilization of broad\u2010 versus narrow\u2010spectrum antibiotics for the treatment of outpatient community\u2010acquired pneumonia among adults in the United States"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4116-512X","authenticated-orcid":false,"given":"Katelin B.","family":"Nickel","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4652-7089","authenticated-orcid":false,"given":"Michael J.","family":"Durkin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7070-9320","authenticated-orcid":false,"given":"Margaret A.","family":"Olsen","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John M.","family":"Sahrmann","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elizabeth","family":"Neuner","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Barnes\u2010Jewish Hospital  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caroline A.","family":"O'Neil","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7307-6864","authenticated-orcid":false,"given":"Anne M.","family":"Butler","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Infectious Diseases Washington University School of Medicine  St. Louis Missouri USA"},{"name":"Department of Surgery, Division of Public Health Sciences Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the CDC Prevention Epicenters Program","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,3,21]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS).Annual number and percent distribution of ambulatory care visits by setting type according to diagnosis group: United States; 2009\u20132010. Accessed June 6 2018.https:\/\/www.cdc.gov\/nchs\/data\/ahcd\/combined_tables\/2009-2010_combined_web_table01.pdf"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1086\/511159"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201908\u20101581ST"},{"key":"e_1_2_10_5_1","unstructured":"FileTM BondS.Treatment of community\u2010acquired pneumonia in adults in the outpatient setting.2023.https:\/\/www.uptodate.com\/contents\/treatment\u2010of\u2010community\u2010acquired\u2010pneumonia\u2010in\u2010adults\u2010in\u2010the\u2010outpatient\u2010setting?search=cap&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H2787226612"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.3390\/biomedicines8110502"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010018\u20104430\u2010x"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofv113"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab637"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.14153"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac879"},{"key":"e_1_2_10_12_1","unstructured":"Centers for Disease Control and Prevention.Antibiotic Resistance Threats in the United States; 2019."},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553\u20102712.2012.01342.x"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03550010046038"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinthera.2006.09.013"},{"key":"e_1_2_10_16_1","unstructured":"Merative.MarketScan Research Databases for life sciences researchers.2023.https:\/\/www.merative.com\/content\/dam\/merative\/documents\/brief\/marketscan\u2010research\u2010databases\u2010for\u2010life\u2010sciences\u2010researchers.pdf"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200405\u2010644ST"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0146822"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc8893"},{"key":"e_1_2_10_20_1","volume-title":"2013 NCHS Urban\u2013Rural Classification Scheme for Counties","author":"Ingram DD FS","year":"2014"},{"key":"e_1_2_10_21_1","volume-title":"Joinpoint Regression Program","year":"2022"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/(sici)1097\u20100258(20000215)19:3<335::aid\u2010sim336>3.0.co;2\u2010z"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/00031305.1980.10483031"},{"key":"e_1_2_10_24_1","unstructured":"Smoothed conditional means. Accessed February 8 2024.https:\/\/ggplot2.tidyverse.org\/reference\/geom_smooth.html"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.4151"},{"key":"e_1_2_10_26_1","unstructured":"US Food & Drug Administration.FDA Drug Safety Communication: FDA updates warnings for oral and injectable fluoroquinolone antibiotics due to disabling side effects. Accessed March 13 2023.https:\/\/www.fda.gov\/drugs\/drug\u2010safety\u2010and\u2010availability\/fda\u2010drug\u2010safety\u2010communication\u2010fda\u2010updates\u2010warnings\u2010oral\u2010and\u2010injectable\u2010fluoroquinolone\u2010antibiotics"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.36662"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2021.1154"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa1404"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00635\u201018"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp160011"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab950"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciq257"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dky075"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1086\/505871"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1086\/341978"},{"key":"e_1_2_10_37_1","volume-title":"Typical Bacterial Pneumonia","author":"Pahal P","year":"2022"},{"key":"e_1_2_10_38_1","unstructured":"Centers for Disease Control and Prevention.Active Bacterial Core Surveillance Report Emerging Infections Program Network Streptococcus Pneumoniae.2016Accessed March 10 2023.https:\/\/www.cdc.gov\/abcs\/reports-findings\/survreports\/spneu16.pdf"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1093\/ofid\/ofab063"},{"key":"e_1_2_10_40_1","unstructured":"Centers for Disease Control and Prevention.Active Bacterial Core Surveillance (ABCs) Report Emerging Infections Program Network Streptococcus Pneumoniae.2019Accessed March 10 2023.https:\/\/www.cdc.gov\/abcs\/downloads\/SPN_Surveillance_Report_2019.pdf"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciac615"}],"container-title":["Pharmacoepidemiology and Drug Safety"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pds.5779","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,10,2]],"date-time":"2024-10-02T08:36:27Z","timestamp":1727858187000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pds.5779"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,21]]},"references-count":40,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2024,4]]}},"alternative-id":["10.1002\/pds.5779"],"URL":"https:\/\/doi.org\/10.1002\/pds.5779","archive":["Portico"],"relation":{},"ISSN":["1053-8569","1099-1557"],"issn-type":[{"value":"1053-8569","type":"print"},{"value":"1099-1557","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,21]]},"assertion":[{"value":"2023-10-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-21","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e5779"}}