Evaluation of outpatient clindamycin prescriptions across a large military healthcare network

OBJECTIVE: Despite concerns regarding toxicity and antimicrobial resistance, clindamycin prescriptions have remained significant at a large military healthcare system. This study evaluates patient and prescriber factors associated with outpatient clindamycin prescriptions.

DESIGN AND SETTING: This study evaluated clindamycin prescriptions filled between January and December 2023 at outpatient pharmacies in a large military healthcare system.

PATIENTS: During the study period there were 1046 outpatients prescriptions for clindamycin among 972 adult and pediatric patients.

RESULTS: The cohort was predominately female (576, 55.1%) with a median age 48 [IQR 27.5-66]. The clinics with the most prescriptions were the emergency department (45.4%), primary care (23.6%), and surgical clinics (14.9%). While there were 533 prescribers, the ten highest writers of clindamycin accounted for 18.1% of all prescriptions. Beta-lactam allergy (38.5% vs. 16.0%, p ≤ 0.00001) was more common in patients with a dental indication and less common in those with a skin and soft tissue infection (51.3% vs. 23.3%, p ≤ 0.00001).

CONCLUSIONS: Despite local guidelines, clindamycin was still frequently used for a variety of indications in a large military healthcare system with high clindamycin resistance rates. Additionally, a small number of providers were found to be responsible for a disproportionate number of clindamycin prescriptions, highlighting potential targets for intervention for future antimicrobial stewardship interventions.