Utilization patterns of second-line antibiotics in a health plan setting.

Increased utilization of second-line antibiotics where first-line agents are appropriate, and the use of antibiotics for viral infections, are leading to the development of resistance. This retrospective study evaluated antibiotic utilization patterns of cephalosporins, macrolides, and quinolones for community-acquired infections in a health plan's patient population. Patients were identified through the health plan's computerized pharmacy claims database. Patients were considered eligible if they had been enrolled with the health plan for at least one year, and had a prescription claim for a cephalosporin, macrolide, or quinolone antibiotic between February 1, 2001 and April 30, 2001. Six hundred fifty patients were randomly selected to undergo chart review. A total of 128 patients (25.2%) from an eligible cohort of 508 health plan members had no documented diagnosis of infection in their chart. Gram staining was checked in 14 patients. Cultures were ordered for only 19 patients. Comparisons were made with regard to first-, second-, and third-line drug use in select documented infections. Of all the patients in the study, only 10.4% (53/508) had chart documentation of previous antibiotic failure. Of the 456 patients who had documentation, 63% had no known antibiotic allergies, and 19% had allergies to penicillin. The results of this study will be used to educate providers and consumers on appropriate antibiotic prescribing.