PDF
Appendix A
Published
2026-05-12
Issue
Section
Pharmacy Practice & Practice-Based Research
Categories
License
Copyright (c) 2026 Benjamin Pontefract, Kushal Dahal, Jacqueline McDonnell, Michael Klepser, Minji Sohn
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Copyright of content published in INNOVATIONS in pharmacy belongs to the author(s).
Differences by patient race in guideline concordant outpatient antibiotic use in adult patients in Michigan
Benjamin Pontefract
https://orcid.org/0000-0002-6675-4409
Kushal Dahal
Ferris State University College of Pharmacy
https://orcid.org/0009-0001-3982-9516
Jacqueline McDonnell
Ferris State University College of Pharmacy
Michael Klepser
Ferris State University College of Pharmacy
https://orcid.org/0000-0001-9025-9099
Minji Sohn
Ferris State University College of Pharmacy
https://orcid.org/0000-0002-7066-7789
DOI: https://doi.org/10.24926/iip.v17i1.6954
Keywords: antibiotic tracking, outpatient, antimicrobial stewardship, race, Black or African American, White, social determinants of health
Abstract
Purpose: To determine if there are significant differences in the rate of guideline concordant antibiotic use by race in adult patients in the state of Michigan.
Methods: Using the Collaboration to Harmonize Antimicrobial Registry Measures (CHARM) database, outpatient prescriptions from 6 health systems throughout the state of Michigan in 2021 were reviewed, and the 5 infectious disease diagnoses with the most antibiotic prescriptions were identified. The 2 most common races amongst patients were identified, and the differences in rates of guideline concordance were compared between them.
Results: A total of 62,070 outpatient prescriptions were identified for the 2 most common races, White and Black or African American. Of those, 43,519 outpatient prescriptions were identified for the top 5 infectious diagnoses, acute cystitis, acute sinusitis, acute pharyngitis, cellulitis, and otitis media. Antimicrobial choice concordance was higher in patients who are White (71.6% vs. 68.5%; p<0.01), while antibiotic dosing concordance was higher in patients who are Black or African American (65.9% vs 68.4%; p=0.02). Differences in antimicrobial choice concordance was primary driven by acute cystitis with more patients who are Black or African American receiving doxycycline (1.1 % vs 6.0%; p<0.01). Differences in antimicrobial dose concordance was primary driven by acute pharyngitis with fewer patients who are White receiving concordant doses of amoxicillin (45.5 % vs 64.6%; p<0.01).
Conclusion: Differences in rates of antibiotic choice and dosing concordance were seen between patients who are White and Black or African American. Further studies investigating the clinical significance of these differences are warranted.
IRB approval: This study was evaluated by the local Institutional Review Board and determined to be exempt because it did not involve human subjects research.
