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Volume 25, Number 7—July 2019

Racial/Ethnic Disparities in Antimicrobial Drug Use, United States, 2014–2015

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To the Editor: We read with interest the article by Olesen and Grad (1), which reported that, in the United States during 2014–2015, the rate of antimicrobial drug use by white persons was twice that of persons of other races. The authors did not relate this finding to previous reports of ≈2 times lower incidence of sepsis (2) and ≈1.5 times lower incidence of death from infectious diseases (3) in white persons in the United States.

A national study of community antibacterial dispensing in relation to ethnicity in New Zealand (4) found that the dispensing rates were highest in Pacific people and Maori, consistent with their higher incidence of infectious diseases. However, the ethnic disparities in dispensing rates were substantially less than the ethnic disparities in the incidence of some infections. For example, even though the incidence of hospitalization for rheumatic fever was 63 times higher for Pacific people and 27 times higher for Maori than for persons of all other ethnicities combined, the annual dispensing rates of penicillins for Pacific people and Maori were <1.5 times higher than in other ethnicities.

Olesen and Grad suggest that ethnic disparities in antimicrobial drug use will lead to disparities in the prevalence of colonization (and disease) by antimicrobial-resistant bacteria. The New Zealand study found that dispensing rates of topical antimicrobial agents (predominantly fusidic acid) for Pacific and Maori children were approximately twice those for children of other ethnicities and suggested that these high dispensing rates might have contributed to the higher proportion of staphylococcal infections caused by methicillin-resistant (and fusidic acid–resistant) Staphylococcus aureus in Pacific people and Maori (5). We suggest that improved understanding of ethnic disparities in the incidence of infectious diseases and in the level of consumption of antimicrobial agents might usefully inform antimicrobial stewardship targets and strategies.


Mark ThomasComments to Author , Naomi Whyler, Andrew Tomlin, and Murray Tilyard
Author affiliations: University of Auckland, Auckland, New Zealand (M. Thomas); Auckland City Hospital, Auckland (M. Thomas, N. Whyler); Best Practice Advocacy Centre, Dunedin, New Zealand (A. Tomlin, M. Tilyard)



  1. Olesen  SW, Grad  YH. Racial/ethnic disparities in antimicrobial drug use, United States, 2014–2015. Emerg Infect Dis. 2018;24:21268. DOIPubMedGoogle Scholar
  2. Martin  GS, Mannino  DM, Eaton  S, Moss  M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348:154654. DOIPubMedGoogle Scholar
  3. Richardus  JH, Kunst  AE. Black-white differences in infectious disease mortality in the United States. Am J Public Health. 2001;91:12513. DOIPubMedGoogle Scholar
  4. Whyler  N, Tomlin  A, Tilyard  M, Thomas  M. Ethnic disparities in community antibacterial dispensing in New Zealand, 2015. N Z Med J. 2018;131:5060.PubMedGoogle Scholar
  5. Williamson  DA, Monecke  S, Heffernan  H, Ritchie  SR, Roberts  SA, Upton  A, et al. High usage of topical fusidic acid and rapid clonal expansion of fusidic acid-resistant Staphylococcus aureus: a cautionary tale. Clin Infect Dis. 2014;59:14514. DOIPubMedGoogle Scholar


Cite This Article

DOI: 10.3201/eid2507.181775

Original Publication Date: May 15, 2019

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Mark Thomas, Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, 85 Park Rd, Grafton, Auckland 1023, New Zealand

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Page created: June 17, 2019
Page updated: June 17, 2019
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The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.