# Evaluation of outpatient clindamycin prescriptions across a large military healthcare network

## TL;DR

This study examines clindamycin prescriptions in a military healthcare system, finding frequent use despite resistance and a small group of prescribers responsible for many prescriptions.

## Contribution

The study identifies patterns and prescriber behaviors in clindamycin use, offering insights for antimicrobial stewardship interventions.

## Key findings

- Clindamycin prescriptions were most common in emergency departments and primary care clinics.
- A small number of prescribers wrote a disproportionate share of clindamycin prescriptions.
- Beta-lactam allergy was more common in dental indications compared to skin infections.

## Abstract

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.

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

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

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).

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.