From VKal and Health Statwtics of the National Center for Health Statrs.tics Number 106 . April 10, 1985 

Use of Topical Antimicrobial Drugs in Office-Based Practice: 

United States, 1980-81 

by Gloria J. Gardocki, Ph. D., Division of Health Care Statistics 

This report examines the use of topical antimicrobial 

medications in the office-based patient care setting. The information used was obtained by combining the 1980 and 1981 

results of the National Ambulato~ Medical Care Survey, a 

sample survey of care provided by office-based physicians. 

Conducted annually by the National Center for Health Staistics from 1973 through 1981, the survey is being carried out 

again in 1985. m Because of the nature of the data collected by means of the 

National Ambulatory Medical Care Survey (NAMCS), the 

investigation of the use of antimicrobial medications is limited 

to an inspection of the patterns in physicians’ ordering or providing them to patients. It is not possible to assess the extent to 

which the patients actually filled their prescription orders and 

used the medications according to instructions. 

The estimates presented in this report are based on a sample 

of office visits, and so are subject to sampling variability. 

Comparisons among statistics were tested for statistical significance using the Bonfemoni test for multiple comparisons, a 

modification of the t-test. Statements regarding differences 

between or among statistics indicate that the test results showed 

a difference significant at the p <.05 level. An explanation of 

sampling errors and guidelines for judging the precision of 

estimates, as well as a brief description of the survey design, 

are presented in the technical notes appended to this report. 

In selecting the drugs to be included in this analysis, AMA 

Drug Evaluations, FI#M Edition, 1 first was utilized to establish 

a comprehensive list of drug in~edients (according to generic 

or nonproprietary name) considered to have antimicrobial 

activity. All drug mentions (that is, all drugs listed by physicians 

as ordered or provided to patients) appearing in NAMCS in 

�lAMA DmgE~a[~~~fons, Fz~th Edition, ChS.21, 24,62, md 69-80. Cticago. 

American Medical Association, 1983. 

1980 and 1981 then were screened for these ingredients. The , 

resulting list of antimicrobial drugs was divided into two sets: 

those known to be used only topically and all others. The topical 

drugs, and the patient visits associated with them, are discussed 

in this repofi, the other antimicrobial drugs will be presented in 

an additional report scheduled for publication in 1985. 

Thirty-six specific antimicrobial generic ingredients ap 

peared in the topical drug mentions recorded in the 1980 and 

1981 surveys. For the purposes of this analysis, they can be 

classified in the following eight categories: 

Amphenicols (chlorarnphenicol).


Macrolide antibiotics (erythromycin).


Tetracycline (chlortetracycline, meclocycline, oxytetra­


cycline, and tetracycline hydrochloride).


Aminoglycosides (gentamicin and neomycin).


Polymyxins (poIymyxin B).


Sulfonamides (silver sulfadiazine, sulfabenzamide, sul­


facetamide, sulfanilamide, sulfathkole, and sulfisoxazole).


Antifungal or antibacterial and antifungal agents (am­


photencin B, selenium sulfide, sodium thiosulfate, tolnaf­


tate, undecyclenic acid, and zinc pyrithione).


Miscellaneous antimicrobial agents (acetic acid, bacitracin,


carbol-fuchsin, gramicidin, iodochlorhydroxyquin, iodo­


quinol, nitrofurazone, povidone-iodine, and silver nitrate).


Although gramicidin, neomycin, and polymyxin B also are 

used systemically, such use is unusual, particularly in the offlcebased ambulatory care setting examined here. Consequently, 

these three generic ingredients are included only in this topical 

antimicrobial report. 

The specific topical antimicrobial drugs containing the 

above generic ingredients and appearing in NAMCS in 1980 

and 1981 were subdivided according to the body site of application and the types of active ingredients included. This yielded 

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service 
2 

seven topical antimicrobial groups with frequencies large � Vaginal drugs: Dregs for vaginal use only, containing one 

enough for analysis: or more antibacterial and/or antifungal agents. v. 

Ophthalmic antibacterial drugs: Drugs for ophthalmic � Other topical antlfingal drugs: D-mgs ‘for use on skir ~ use only, containing one or more antibacterial agents. and/or mucous membranes, containing one or more antiOphthalmic antibacterial-corticosteroid mhtures: Drugs fungal ingredients.


for ophthalmic use only, containing one or more antibac- � Other topical anti-i$ectives: Drugs for use on skin and/or


terial agents and one or more corticosteroids. (These drugs mucous membranes, containing one or more antibacterial


have anti-inflammatory as well as anti-infective properties.) ingredients and/or antibacterial and antifungal agents. 

� Otic drugs: Drugs for otic use only, containing one or � Other topical anti-injective and corticosteroid mixtures: 

more antibacterial. and/or antifimgal agents, with or without	 Drugs for use on skin and/or mucous membranes, containing antibacterial and/or antibacterial and a corticosteroid’ i~gredient. 

Ophthalmic antibacterial drugs 

Bleph


Chloromyxin


Chloroptic


Econochlor


Genoptic


Iaopto Cetamlde


Ophthochlor


Statrol


Sulamyd


Sulfacel-1 5


Vaaosulf


Ophthalmic antibacterial-conicoateroid 

mixtures 

Blephamlde


Cetapred


Chloromycetin-Hy drocotiisone


Chloroptic-P


Isopto Cetapred


Maxitrol


Metimyd


Neo-Hydeltrasol


Ophthocort


Optimyd


Poly-Pred


Sulfapred


Vasocidin


Otlc drugs 

Chloromycetin Otic


Domeboro Ot!c


Dureze


Lidosponn


Neo-Cort-Dome Otic


otic drops


Otobione


Otobiotic


Otocort


Otoreld-HC


Pyoc!din


V6SOI


V&sol-HC


Vaginal drugs 

AVC


AVC/Dienestrol


Betadine Vaginal Oouche


Candeptin


Femguard


one or more 

gentien violet BPN 

Gyne-Lotrimin carbol-fuchsin 

Koro-Sulf Castellani’s paint 

Monistat 7 Efodine 

Nylmerate Elase-Chloromycetin 

nystatln vaginal tablet EryDerm 

Sulfa Vaginal Furacin 

sulfanilamide Iodochlor 

Sultrin Meclan 

Tricholan Mity-Mycin 

Triconol Mycltracin 

Tripul Vaginal neomycin 

Vagina Neo-Polycin 

Vagitrol Neosponn 

Vanobid nitrofurazone 

Polysr30rin 

Other topical antifungal druga	 Polytracln 

povidone-iodine 

amphotericin Sebizon Lotion


clotrimazole Silvadene


Desenex silver nitrate


Exsel Lotion silver nitrate toughened sticks


Fungizone stlver sulfadiazine


Fungizone Lotion Spectro-Biotic


Halotex Staticin


Head and Shoulders sulfacetamide


Lotrimin Sulfacet-R


MicaTin sulfathiazole


miconazole Thiaphyll


Monlstat Toplcycline


Mycelex Triple Arrtibiotlc


Nystaform Vioform


selenium


Selsun Other topical anti-infective and 

Selsun Blue corticosteroid mixtures 

Tinactin 

Tinver Lotion Caquin 

undecyclenic acid Cordran-N 

Verdefam Cor-Tar-Quin 

Zincon Cortisporin 

F-E-P 

Other topical anti-infectives	 hydrocortisone-neomycin 

MYcoloa 

AIT/S Mytrex -

acetic acid Neo-Cortef 

acetic acid glaciel Neo-Decadron 

Aureomycin Neo-Delta-Cortef 

Bacimycin Neo-Medrol 

bacitracin Neo-Synalar 

bacitracin-neomy cin-polymyxin Racet 

Betadine Terre-Cortril 

Biotres Vioform-Hydrocortts one 

Biozyme Vytone 

Figure 1. Topical antimicrobial drugs named by physician respondents: United States, 19S0-81 
@mcecMa3 

antifungal ingredients and one or more corticosteroid ingredients. (These drugs also have anti-inflammatory and 

anti-infective properties. ) 

All analyses in this report are based on this categorization 

of topical antimicrobial. The trade2 and generic names used 

by physicians in reporting the specific drugs that appeared in 

NAMCS in 1980 and 1981 are displayed according to category 

in figure 1. 

GeneraI findings 

The 1980 and 1981 total number of oftice visits to physicians principally engaged in oftlce-based practice, estimated 

by means of NAMCS, was 1.1 billion. Of these visits, 62 percent 

(0.7 billion) were drug visits, that is, visits at which one or 

more therapeutic medications were ordered or provided. The 

drug visits involved a total of 1.3 billion drug mentions. 

The drug mentions defined as topical antimicrobial numbered 48.4 million, or 3.6 percent of all drug mentions. This 

reflected an average annual rate of 108.6 topical antimicrobial 

drugs per 1,000 population. (See table 1.) The most frequently 

mentioned groups were other topical anti-in fectives, with 13.1 

million mentions (27.0 percent of the total), other topical antiinfective and corticosteroid mixtures, with 10.5 million mentions (21.6 percent), and vaginal drugs, with 8.1 million 

mentions (16.8 percent). Although vaginal drugs had an annual 

average rate of 35.2 per 1,000 female population, other topical 

mtti-infectives had a rate of 29.4 per 1,000 population, and 

other topical anti-infective and corticosteroid mixtures had a 

rate of 23.5 per 1,000 population, these differences are not 

statistically significant. 

The 15 specific topical antimicrobial drugs mentioned 

most frequently are listed in table 2. Together they accounted 

for almost two-thirds of all drug mentions of this type. 

Of the drug mentions under consideration, combination 

drugs (that is, those containing multiple active ingredients) 

constituted the majority (27.3 million drug mentions, or 56.1 

2The use of trade “ame~ is for identification only and does not imPIY endorsement by the Public Health Service or the U.S. Department of Health and Human 

Services. 

Table 2. Number and percant distribution of tha 15 topical 

antimicrobial drugs most frequently mentioned in office-based 

prectice: United States, 1980–81 

Number of 

Name of drug and mentions in Percent 

Rank antimicrobial ingredients thousands distribution 

All topical antimicrobial drugs. 

1 Cortwporin (polymyxm B, 

bacitracin, and neomycin) 

2 Neosporin (polymyxin B, 

bacitracin, and neomycin) 

3 Mycolog (nystatin, neomycin, 

andgramicid in),,,,..,,,.. 

4 Maxitrol (neomycin and 

polymyxin B) . . . . . . . . . . . . . . . 

5 Monistat 7 (miconazole) 

6 AVC (sulfanilamide) 

7 Monistat (miconazole) 

8 Lotrimin (clotrimazole) . 

9 Chloroptic (chloramphenicol). . 

10 Sultrin (sulfathiazole, 

sulfa cetamide, and 

sulfabenzam]de) 

11 8etadine (povidone-iodine) 

12 Gyne-Lotrimin (clotnmazole) 

13 Neo-Decadron (neomycin) 

14 Bacitracin . . . . . . . . . . . . . . . . . . 

15 Silver nitrate . . . . . . . . . . . . . . . . 

All other topical and 

antimicrobial drugs. 

48,354 100.0 

4,988 10,3 

4,664 9.6 

2,883 6,0 

2,057 4.3 

1,906 3.9 

1,828 3.8 

1,813 3.7 

1,755 3.6 

1,507 3.1 

1,271 2.6 

1,214 2.5 

1,189 2.5 

1,184 2,4 

1,016 2.1 

959 2,0 

18,119 37.5 

percent). The remainder (21. 1 million, or 43.9 percent) were 

single ingredient drugs. Table 3 lists the 15 generic ingredients 

most frequently included in all topical antimicrobial drug mentions. Together these substances account for more than threefourths (78.0 percent) of the 109.8 million ingredient mentions 

listed for these drugs. Although 9 of the 15 most common ingredients were antibacterial or antifungal in nature, 6 were not. 

These latter ingredients were principally anti-inflammatory in 

their effects. 

NAMCS data files also contain American Hospital 

Formulary Service information as to the expected therapeutic 

3A~erican ~o~p~taf F~rm~/a~ Service C/ass{@cation System and Therape~lic 

Category Codes, Washington. American Society of Hospital Pharmacists, Inc., 

1980. 

Table 1. Number, percent distribution, end average annual rate of topical antimicrobial drug mentions in office-based practice by drug group: 

United States, 1980-81 

Average annual 

rate per 1,000 

Number of civilian nonmentions in Percent institutionalized 

Drug group thousands distribution poptdation 

Alltopical antimicrobial drugs,., . . . . . . . . . . . 48,354 100,0 108.6 

Ophthalmic anti bacteria l drugs,,,. . . . . . . 3,471 7.2 7,8 

Ophthalmic anti bacterial-corticosterotd mixtures, , . . . . . . . . . . . . . . . . . . . . . . 4,558 9.4 10,2 

2tic drugs.................,.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,487 3.1 3.3 

Vaginal drugs . . . . . . . . . . . . . . . . . . . . . ,, 8,106 16,8 ‘35.2 

Other topical antifungal drugs,... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,198 14,9 16.2 

Other topical anti-infectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .,,.....,,,...,,,...,,,,, 13,074 27.0 29.4 

Other topical anti-infective and corticosterold mixtures. ., . . . . 10,460 21.6 23.5 

I Rata is based on the female population only. 
1

2

3

4

5

6

7

8

9

10

11

12

4 

Table 3, Number and percent distribution of the 15 generic ingredients most frequently eppearing in topical antimicrobial drug mentions, with 

principal therapeutic action: United States, 1980 and 1981 

,4 

Number of 

generic ingredient 

Principal therapeutic mentions in Percent 

Rank Generic ingredient action thousands distribution 

Allgenenc ingredients..,....,.. . . . . . . . . . . . . . . . . . . . . . . . . . 109,809 100.0 

Neomycin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Anti bacterial 17,585 16.0 

Polymyx(n B,, , . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Anti bacterial 13,966 12.7 

8acltracln ..,...,..,..,,,,,,.,,, ,,, ,,, ,,, ,,, ,,, ,,, ,,, Antibacterial 12,128 11.0 

Hydrocortlsone, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Anti-inflammatory 6,564 6.0 

Sulfacetamlde, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Antlbactenal 5,836 5,3 

Miconazole, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Antifungal 4,447 4.0 

Clotrlmazole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Antifungal 3,727 3.4 

Dexamethasone ..,..,...,..,,.. . . . . . . . . . . . . . . . . . . . . . . . . Anti-inflammatory 3,241 3,0 

Nystattn. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Antifungal 2,948 2.7 

Trlamclnolone. ..,..,..,,..,,.. . . . . . . . . . . . . . . . . . . . . . . . . . Anti-inflammatory 2,916 2.7 

Gramlc[d, n,, . ., . .,, ,, . . . . . . . . . . . . ,,, ,,, ,,, ,,, ,,, ,,, Antibacterial 2,883 2.6 

Prednlsolone ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Anti-inflammatory 2,442 2.2 

13 Sulfanilamlde, ...,..,...,,..,,. . . . . . . . . . . . . . . . . . . . . . . . . Antibacterial 2,435 2.2 

14 Allantoln, ..,,..,,..,...,,,.,,, ,,, ,,, ,,, ,,, ,,, ,,, ,, Stimulation of healthy tissue growth 2,255 2.1 

15 Amlnacrlne . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Bacteriostatic 2,255 2.1 

All others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24,181 22,0 

Other 

Antt-lnfectwe (0.7%) Skin and 

agents \ 1 mucous 

(i2 

Eye, ear, nose,


and throat A


preparations w


(34.9%) w


NOTE: American Hospitsl Formulsty SewIce categories are gwen In 

American Hosp/ta/ Formula~ Service Classification System and 

Therapeutic Category Codes. Washington. American Society of Hospital 

Pharmacists, Inc., 1980. 

Figure 2, Distribution of topical antimicrobial drugs among 

American Hospital Formulary Service therapeutic categories: 

United States, 1980–81 

effects of drugs mentioned. The therapeutic categories associated 

with the topical antimicrobial drugs selected for examination in 

this report are illustrated in figure 2. A slight majority (5 1.6 

percent) of the drugs were classified as skin and mucous membrane preparations, and another large segment (34.9 percent) 

was classified as eye, ear, nose, and throat preparations. 

Overall, most of the topical antimicrobial medications 

(90.6 percent) were available to patients only as prescription 

drugs. Of the ones available without prescription, two-thirds 

(67.2 percent) were classified for this report as other topical 

anti-in fectives. Three of the drug groups—ophthalmic antibacterial drugs, ophthalmic antibacterial-co rticosteroid mixtures, and other topical anti-infective and corticosteroid mixtures—were composed of prescription dregs only. Prescription 

drugs dominated the remaining drug groups also, but in varying 

proportions, ranging from 76.6 percent of other topical antiinfectives to 97.1 percent of otic drugs. 

Visits involving topical antimicrobial drugs 

During 1980 and 1981 there were 46.0 million patient visits 

in which at least one topical antimicrobial drug was ordered or 

provided. This represented one out of every 25 (4.0 percent) 

ofllce visits that occurred during that period. 

For these visits there was an average of 1.05 topical antimicrobial drug mentions per visit, an intensity rate indicating 

that the simultaneous order or provision of multiple drugs of 

this type was an exceptional event. In fact, two or more of 

these drugs were ordered or provided in only 2.2 million visits, 

or 4.9 percent of all topical antimicrobial drug visits. 

Patient demographics 

As shown in table 4, the overall average annual rate of 

visits was 103.4 per 1,000 civilian noninstitutionalized population. The greatest number of visits (13.6 million, or 29.6 percent of all these visits) was made by persons 25–44 years of 

age. Females made a substantial majority (62.3 percent) of the 

visits involving topical antimicrobial, which did not differ 

noticeably from the proportion of all other office visits made by 

females (60.3 percent). Controlling for the relative sizes of the 

male and female populations, the female rate of 124.4 visits 

per 1,000 population per year was 54 percent higher than the 

male rate of 80.6. 

The racial distribution of visits shows that white persons T 

made 88.3 percent of the visits involving topical antimicrobial 

drugs and persons of all other races made 11.7 percent, proportions that did not differ significantly from those observed for 
5


Table 4. Number, percent distribution, and average annual rate of 

visits involving topical antimicrobial drugs by age, sex, and race: 

United States, 1980-81 

Rate per 1,000 

Number of civilian nonvisits in Percent institutionalize e d 

Age, sex, and race thousands distribution population 

All topical 

antimicrobial drug 

visits . . . . . . . . . . . . . 46,034 100.0 103,4 

Age 

14 years and under. 9,509 20.7 93,5 

15–24 years.,...,,. 7,953 17.3 97.7 

25–44 years...,,,.. 13,625 29,6 108.7 

45–64 years ..,,..,, 8,173 17,8 93.0 

65 years and over 6,773 14.7 38.2 

Sex 

Male . . . . . . . . . . . . . . 17,361 37,7 80.8 

Female . . . . . . . . . . . . 28,673 62.3 24.4 

Race 

White, ...,,,...,.. 40,662 88.3 106.4 

Another . . . . . . . . . . . 5,372 11,7 84.9 

all other visits. The visit rate for white persons (106.4 per 1,000 

population per year) was 25 percent higher than that for all 

others (84.9). 

Age, sex, and race distributions varied somewhat among 

visits involving different types of topical antimicrobial drugs. 

Excluding vaginal drugs, the largest sex differences appeared 

in the visits involving other antzjiungal drugs (36.4 percent of 

which were made by males) and ophthalmic antibacterialcorticosteroid mixtures (41.9 percent of which were made by 

males). One factor influencing these sex differences is that 

some of the other antifungal drugs may be used vaginally. 

The age distribution of patients who received ophthalmic 

antibacterial-co rticosteroid mixtures reflects the significant 

number of cataract patients. Fully one-third of the patients receiving these drugs (34.7 percent) were at least 65 years old, 

and an additional 25.1 percent were 45–64 years of age. In 

fact, the median age for all patients receiving this type of drug 

was 56.9, which was strikingly higher than the median age of 

31.0 for all patients who received topical antimicrobial drugs. 

Similarly, the use of vaginal drugs was heavily concentrated in the middle age range. The median age of 29.6 years 

for the patients receiving these drugs reflects the 77.1 percent 

of these patients who were 15–44 years of age, and is influenced 

by the relatively high susceptibility of women in the child-bearing 

years to vaginal infections and inflammation. 

The final major age difference in the use of the specific 

types of topical antimicrobial drug was that children accounted 

for disproportionate numbers of visits involving otic drugs 

(36.9 percent), other topical anti-in fectives (27.0 percent), 

and other topical anti-infective and corticosteroid mixtures 

(30.9 percent). The median patient ages of 24.4, 29.7, and 

27.2, respectively, for these groups thus may be indicative of 

the relative susceptibility of youth to otic infections and superficial injuries. 

Significant race differences in utilization of the different 

types of topical antimicrobial were observed, but possible 

explanations for these differences are unclear. Of the patients 

who were ordered or provided with topical antimicrobial drugs, 

persons of minority races were more likely than white persons 

to be users of vaginal drugs (28.3 percent compared with 15.7 

percent) and other topical anh~ungal drugs (23.8 percent compared with 14.0 percent). The reverse was true for other topical 

anti-infective drugs-29. 1 percent of the white patients receiving 

topical antimicrobial were ordered or provided with this type 

of drug, compared with 18.9 percent of minority race patients. 

Utilization of other topical anti-infective and corticosteroid 

mixtures, however, showed no difference between these two 

racial groupings. Because the frequencies of use of ophthalmic 

antibacterial drugs, ophthalmic antibacterial-co rticosteroid 

mixtures, and otic drugs by minority race persons were too 

small to be statistically reliable, race differences in utilization 

of these drugs could not be tested. 

Physician specialty and patients’ reasons 

for visit 

The distribution of visits involving topical antimicrobial 

drugs according to physician specialty is presented in table 5. 

Although general and family practitioners were the most frequently involved physicians (13.2 million visits, or 28.6 percent 

of the total), they handled a somewhat smaller proportion of 

these visits than of all other visits (33.1 percent). Also, the 

physicians who utilized topical antimicrobial drugs were more 

concentrated than other physicians in the specific few specialties 

most concerned with the types of illness and injury associated 

with the use of these medications—dermatology ( 11.2 percent 

of the visits involving topical antimicrobial drugs, compared 

with 4.1 percent of all other visits), obstetrics and gynecology 

( 14.3 percent compared with 9.2 percent), ophthalmology 

(17.9 percent compared with 4.9 percent), and otolaryngology 

(4.4 percent compared with 2.2 percent). In fact, these four 

specialty groups alone accounted for almost half(47.8 percent) 

of all topical antimicrobial drug visits, but only one-fifth (20.4 

percent) of all other visits. 

Because so many infective processes are acute problems 

rather than chronic ones, it was expected that visits involving 

topical antimicrobial drugs would reflect more patients presenting 

for acute care and with new problems. The data presented in 

Table 5. Number and percent distribution of visits involving topical 

antimicrobial drugs by physician specialty: United States, 1980-81 

Number of 

visits in Percent 

Physician specialty thousands distribution 

All specialties..,,.....,,,,.. 46,034 100.0 

General and family practice. . ., 13,170 28.6 

Intern al medic ice .,, . . . . . . . . 2,298 5.0 

Pediatrics . . . . . . . . . . . . . . . . . . 4,872 10,6 

Dermatology . . . . . . . . . . . . . . . . . . 5,170 11.2 

Genera l surgery......,,....,., ,. 1,589 3.5 

Obstetrics and gynecology ., 6,575 14,3 

Ophthalmology . . . . . . . . . . . . . . . . . 8,222 17,9 

Otolaryngology ..,..,,,,,.,,,, 2,044 4.4 

All other specialties . . . . . . . . . 2,094 4,5 
6 advancedata 

table 6 demonstrate that this was indeed the case. A majority Table 8. Number and percent distribution of the 15 specific 

of the patients receiving topical antimicrobial drugs (58.4 per- principal reaaona for visit most commonly given during visits 

involving topical antimicrobial drugs: United States, 1980-81 

cent) presented with an acute problem, compared with only


one-third (35.5 percent) of all other patients. However, the Number of \


proportion who presented for postsurgery or injury care was Most common reason for visit visits in Percent Q


Rank and RVC codel thousands distribution 

the same, 8.8 percent, for both types of visit. More than half 

(55.7 percent) of all visits involving topical antimicrobial drugs All topical antimicrobial drug 

were prompted by new problems. In contrast, only one-third visits . . . . . . . . . . . . . . . . . . . . . 46,034 100.0 

(35.9 percent) of all other visits involved a new problem. 1 Skin rash . . . . . . . . . . . . . (s860) 3,384 7.4 

The principal reasons cited by patients for making oftlce 2 Earache or ear infection. . . (S355) 2,936 6.4 

visits are summarized in tables 7 and 8. A full two-thirds (68.8 3 

4 

Vaginal discharge . . . . . (S760) 

Other vaginal symptoms. (S765) 

2,331 

2,160 

5.1 

4.7 

percent) of all patients receiving topical antimicrobial drugs 5 Abnormal sensations of the 

gave a symptom as their principal reason for visit. In contrast, eye . . . . . . . . . . . . . . . . ..(S32O) 1,941 4.2 

only half (53.5 percent) of all other patients said they visited a 6 

7 

Skin lesion . . . . . . . . . . . ..(S865) 

Postoperative visit. . . (T205) 

1,622 

1,573 

3.5 

3.4 

physician primarily because of a symptom. Patients receiving 8 Abnormal appearance of 

topical antimicrobial drugs also cited injuries and adverse effects eyes . . . . . . . . . . . . . . . . . (s330) 1,195 2.6 

more frequently than other patients did (7.8 percent compared 9 

10 

Foreign body in eye. . . (J600) 

Progress visit, NOS . . . (T800) 

1,035 

1.008 

2.2 

2.2 

with 3.9 percent) and cited diagnostic, screening, and preventive 11 General medical 

reasons and treatment-oriented reasons less frequently (8. 3 examination . . . . . . . . . . . (xl 00) 962 2.1 

percent compared with 19.9 percent, and 6.9 percent compared 

with 10.6 percent, respectively). 

12 

13 

14 

Discharge from eye. . (S31 O) 

Skin irritations, NEC . . . . . (S870) 

Acne or pimples . . . . . . . (S830) 

951 

775 

750 

2.1 

1.7 

1.6 

Of the 15 most commonly cited specific reasons for visit, 5 15 Symptoms of eyelids. . (S340) 680 1.5 

were related to eye problems, 4 to skin problems, 2 to vaginal All other reasons for visit. . . . . . 22,729 49,4 

‘ National Center for Health Statistics, D. Schneider, L. Appleton, and 

T. McLemore: A reason for visit classification for ambulatoy care [RVC]. 

Table 6. Number and percent distribution of visits involving topical Vita/ and Hea/t/r Statistics. Series 2, No. 78. DHEW Pub, No, (PHS) 79–1 352. 

antimicrobial drugs by major reason for visit and patient status: Public Health Service. Washington. U.S. Government Printing Office, Feb. 1979. 

United States, 1980–81 

Major reason for visit and 

patient status 

Number of 

visits in 

thousands 

Percent 

distribution 

symptoms, and 1 to ear symptoms. Twelve of these 15 reason, 

explicitly mention specific body areas with which topical anti 9 

microbial drugs are concerned. The relatively large proportions 

All topical antimicrobial drug visits. . . 46.034 100.0 of visits precipitated by problems labeled as acute and/or new, 

the dominance of symptoms as the principal reasons for visit, 

Major reason for visit and the contents of the most common patient complaints together 

Acute pro blem, ., . . . . . . . . . . . . . . . . . . . 26,876 58.4 reflect the often acute nature of the problems underlying the 

Chronic problem . . . . . . . . . . . . . . . . 

Postsurgey or injury. . . . . . . . . . . . . . . . . . 

11,774 

4,065 

25.6 

8.8 visits of interest. 

Nonillness care . . . . . . . . . . . . . . . . . . . . . 3,319 7.2 

Patient status 

New patient . . . . . . . . . . . . . . . . . . . . . 8,887 19,3 Patients receiving topical antimicrobial drugs were ordered 

Returning patient, new problem . 16,754 36.4 or provided with an average of 1.6 diagnostic services per visit, 

Returning patient, old problem . . . . . . . 20,392 44,3 the same as all other patients. The types of services differed, 

however. The topical antimicrobial drug patients more frequently were ordered or provided with limited histories and/or 

Diagnostic services and diagnoses

Table 7. Number and percent distribution of visits involving topical exams (78.0 percent compared with 63.8 percent), Pap tests 

antimicrobial drugs by principal reason for visit module: (8.0 percent compared with 4.2 percent), and vision tests (13.1 United States, 1980-81 percent compared with 5.4 percent). Fewer of them received 

Number of no diagnostic services (3.5 percent compared with 8.3 percent), 

visits in Percent general histories and/or exams ( 11.7 percent compared with 

15.6 percent), X-rays (1.6 percent compared with 7.7 percent), 

All topical antimicrobial drug visits. . . . 46,034 100.0 and blood pressure checks (23.0 percent compared with 34.7 

Symptom . . . . . . . . . . . . . . . . . . . . . . . . 

Disease . . . . . . . . . . . . . . . . . . . . . . 

31,666 

3,005 

68.8 

6.5 

percent). (See table 9.) 

By far the most common class of principal diagnosis asDiagnostic, screening, and preventive 3,815 8.3 signed to patients receiving topical antimicrobial drugs was Treatment . . . . . . . . . . . . . . . . . . ., .,.,,, 

Injuries and adverse effects. . . . . ., 

3,157 

3,611 

6.9 

7.8 

diseases of the nervous system and sense organs.4 (Se 

Principal reason for visit module 1 thousands distribution 

Other . . . . . . . . . . . . . . . . . . . . . . . . . . .,. 711 1.5 m 4Ba~ed on pub[i~ Health se~i~e and I+ealth Care Financing Administratiorc — 

lBased on National Canter for Health Statistics, D. Schneider, L. Appleton,


and T. McLemore: A reason for visit classification for ambulato~ care [RVC], 

International C[asslJication of Diseases, 9th Revision, Clinical Modification.


Vita/ avrdHea/th Statistics. Series 2, No, 78, DHEW Pub, No. (PHS) 79–1 352, DHHS Pub. No. (PHS) 80-1260, Public Health Service. Washington. U.S. 

Public Health Setvice. Washington, US, Government Printing Office, Feb. 1979. Government Printing Ofiice, Sept. 1980. 
Tabla 9. Number and percent of offica visits involving a topical 

antimicrobial drug by diagnostic service ordered or provided: 

United States, 1980-81 

Number of 

visits in 

Diagnostic service thousands Percentl 

All topical antimicrobial drug visits . . . . . . . . 46,034 100.0 

No diagnostic services . . . . . . . . . . . . . . . . . . 1,597 3.5 

Limited history/examination. . . . . . . . . . . . . . 35,914 78.0 

General histo~/examination . . . . . . . . . . . . . 5,368 11.7 

Pap test . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,658 8.0 

Clinical lab test . . . . . . . . . . . . . . . . . . . . . . . . 9,079 19.7 

Blood pressure check . . . . . . . . . . . . . . . . . . . 10,601 23.0 

Vision test . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,008 13.1 

X-ray . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 744 1.6 

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,432 7.5 

‘Column does not add to 100.0 percent because multiple diagnostic services 

were ordered or provided during some visits. 

table 10.) The 13.3 million patients who were so diagnosed 

constituted 28.8 percent of the entire group; in contrast, only 

8.6 percent of all other patients had this type of principal 

diagnosis. Three other major categories of principal diagnosis 

also were much more common among patients receiving topical 

antimicrobial drugs than among other patients: infectious and 

parasitic diseases (15.2 percent compared with 2.8 percent), 

diseases of the genitourinary system (12.5 percent compared 

with 5.6 percent), and diseases of the skin and subcutaneous 

- sue (14.5 percent compared with 5.6 percent). These groups 

diagnoses clearly are related to the type of drug under cona deration. This relationship between diagnosis and therapeutic 

medication can be seen in more detail in table 11, which presents 

the 15 most common specific diagnoses. All of them are concerned with the body sites to which topical antimicrobial drugs 

are applied, and together they account for more than half (52. 1 

percent) of all visits involving these drugs. 

As was expected, the most common diagnoses varied 

among the groups of patients receiving the different types of 

Table 10. Number and percent distribution of office visits involving 

topical antimicrobial drugs by class of principal diagnosis: 

United States, 1980-81 

Number of 

visits in Percent 

Diagnostic class thousands distribution 

All topical antimicrobial drug visits. . . . . . 46,034 100.0 

Infectious and parasitic diseases. . . . . . . . 6,985 15.2 

Diseases of the nervous system and 

sense organs . . . . . . . . . . . . . . . . . . . . . . . 13,254 28.8 

Oiseases of the respiratory system . . . . . . 1,666 3.6 

Diseases of the genitourinary system . . . . 5,793 12.6 

Diseases of the skin and subcutaneous 

tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,679 14.5 

Injury and poisoning . . . . . . . . . . . . . . . . . . 4,423 9.6 

Factors influencing health status and 

ontact with health service . . . . . . . . . 3,068 6.7 

other diagnoses l . . . . . . . . . . . . . . . . . . 4,167 9.1 

Includes neop[asms: endocrine, nutritional, and metabolic diseases 

and ]mmunlty disorders; mental disorderx diseases of the circulatory system; 

diseases of the d!gestive system; d!seases of the musculoskeletal system; 

symptoms, signs, and 111-defmedcondltaons; and other. mlssang, and unknown 

diagnoses. 

admceda7 

Table 11. Number and percent distribution of the 15 specific 

principal diagnoses most commonly recorded during visits involving 

topical antimicrobial drugs: United States, 1980–81 

Number of 

Most common principal visits in Percent 

Rank diagnosis and ICD-9-CM code~ thousands distribution 

All topical antimicrobial drug 

visits . . . . . . . . . . . . . . . . . . . . . . 46,034 100.0 

1 Inflammatory disease of cervix, 

vagina, and vulva. . . . . . . .(616) 3,570 7.8 

2 Disorders of conjunctiva l... (372) 3,394 7.4 

3 Candidiasis . . . . . . . . . . . . ..(112) 2,561 5.6 

4 Disorders of external ear. . . (380) 2,367 5.1 

5 Suppurative and unspecified 

otitis media . . . . . . . . . . ..(382) 2,215 4.8 

6 Dermatophytosis . . . . . . . . . (1 10) 1,775 3.9 

7 Inflammation of eyelids . . . . (373) 1,544 3.4 

8 Contact dermatitis and other 

eczema . . . . . . . . . . . . . . . . (692) 1,274 2.8 

9 Diseases of sebaceous 

glands . . . . . . . . . . . . . . . .. (706) 1,125 2.4 

10 Superficial injury of eye and 

adnexa . . . . . . . . . . . . . . . . (918) 1,011 2.2 

11 Cataract . . . . . . . . . . . . . . . (366) 729 1.6 

12 Foreign body on external 

eye . . . . . . . . . . . . . . . . . . (930) 632 1.4 

13 Other disorders of eye . . . . . (379) 607 1.3 

14 Dermatomycosis, other and 

unspecified . . . . . . . . . . . ..(l 11) 595 1.3 

15 Keratitis . . . . . . . . . . . . . . . . (370) 578 1.3 

. . . All other diagnoses . . . . . . . . . . . 22,056 47.9 

1Based on Public Health Servic.~ and Health Care Financing Administration: 

international Classification of Diseases, 9th Revision, Clinical Modification 

[ICD–9–CM]. DHHS Pub. No. (PHS) 80–1 260. Public Health Service. 

Washington, U.S. Government Printing Office, Sept. 19B0. 

topical antimicrobial drug. For several of these drug groups, 

particular diagnoses accounted for a relatively large proportion 

of visits. Among patients receiving ophthalmic antibacterial 

drugs, disorders of conjunctival was the principal diagnosis for 

28.2 percent (944,000 visits) of all patients receiving this type 

of drug. Among patients receiving the related ophthalmic antibatten-al-corticosteroid mixtures, the most common principal 

diagnoses were disorders of conjunctival (866,000 visits, or 

19.4 percent), inflammation of eyelids (590,000 visits, or 13.2 

percent), and cataract (584,000 visits, or 13.1 percent). Two 

diagnoses accounted for almost three-fourths of all patients 

receiving otic drugs: disorders of external ear (603,000 visits, 

or 40.5 percent) and suppurative and unspecit3ed otitis media 

(486,000 visits, or 32.7 percent). Similarly, among patients 

receiving vaginal drugs, two diagnoses accounted for half of all 

visits: inflammatory disease of cervix, vagina, and vulva 

(2,693,000 visits, or 34.0 percent); and candidiasis (1,409,000 

visits, or 17.8 percent). Among patients receiving other topical 

antl&zgal drugs, five diagnoses reached reliable levels: dermatophytosis (1,528,000 visits, or 21.9 percent); candidiasis 

(903,000 visits, or 12.9 percent); diseases of sebaceous glands 

(856,000 visits, or 12.3 percent); other and unspecified dermatomycosis (561,000 visits, or 8.0 percent); and inflammatory 

disease of cervix, vagina, and vulva (473,000 visits, or 6.8 

percent). Two principal diagnoses attained reliable levels 

among patients receiving other topica[ anti-infectives: disorders 

of conjunctival (1,210,000 visits, or 9.4 percent) and impetigo 

(529,000 visits, or 5.1 percent). Finally, of the patients receiv-
8 advancedata 

ing other topical anti-infective and corticosteroid mixtures, 

four principal diagnoses appeared in reliable numbers: disorders 

of external ear ( 1,673,000 visits, or 16.1 percent), suppurative 

and unspecified otitis media (1,473,000 visits, or 14.2 percent), 

contact dermatitis and other eczema (75 1,000 visits, or 7.2 

percent), and disorders of conjunctival (478,000 visits, or 4.6 

percent). 

Therapeutic services, patient 

disposition, and visit duration 

An average of 0.5 nonmedication therapeutic services 

were ordered or provided during each visit made by patients 

receiving topical antimicrobial drugs. This was not significantly 

different from the average for all other patients (0.6). Statistics 

on specific types of therapeutic services are displayed in 

table 12. Slightly more than half the patients receiving topical 

antimicrobial drugs (26.0 million, or 56.4 percent) obtained no 

nonmedication therapeutic services, a proportion that did not 

differ from that for all other patients. The topical antimicrobial 

drug patients, however, did receive ofllce surgery at a higher 

rate (12.4 percent compared with 7.2 percent) and psychotherapy 

or therapeutic listening, diet counseling, and family or social 

counseling at lower rates (0.9 percent compared with 5.1 percent, 3.2 percent compared with 8.3 percent, and 0.9 percent 

compared with 2.1 percent, respectively). Thus patients receiving topical antimicrobial drugs did not differ from other patients 

with respect to nonmedication therapeutic services rendered as 

much as they dld with respect to diagnostic services performed. 

The disposition of patients receiving topical antimicrobial 

drugs differed somewhat from that of other patients, but these 

differences also were not large ones, No followup was ordered 

for virtually identical proportions of each type of patient ( 11.4 

percent of patients receiving topical antimicrobial drugs and 

11.5 percent of all others). Patients who received topical antimicrobial drugs were instructed to return at a specified time 

somewhat less frequently than others (56.5 percent compared 

with 60.8 percent), but were requested to return if needed 

somewhat more frequently (29.6 percent compared with 22.4 

percent). (See table 13.) 

Table 12. Number and percent of ol%ce visits involving topical 

antimicrobial drugs with nonmedication therapeutic services 

ordered or provided, by type of service: United States, 1980-81 

Number of 

visits in 

Nonmedication therapeutic service thousands Percent 1 

All topical antimicrobial drug visits . . . . . 46,034 100,0 

No nonmedication therapeutic services . . . . 25,960 56.4 

Physiotherapy . . . . . . . . . . . . . . . . . . 1,691 3.7 

Office surge~ . . . . . . . . . . . . . . . . . . .,, ,., . 5,690 12.4 

Family planning . . . . . . . . . . . . . . . . . 1,193 2.6 

Psychotherapy or therapeutic listening ., . . *420 “0.9 

Diet counseling . . . . . . . . . . . . . . . . . . . . 1,478 3.2 

Family or social counseling ., *41 7 “0,9 

Medical counseling...,,...,,. . . . . . . . . 11,181 24.3 

Other nonmedication therapy, ., 986 2.1 

‘Column does not add to 100.0 percent beceuse multiple nonmedication 

therepy services were ordered or provided during come visits. 

Table 13. Number and percent distribution of office visits involving 

toDical antimicrobial drugs by patiant disposition: United State% 

1980-81 

Number of 

visits in Percent 

Patient disposition thousands distribution 

All topical antimicrobial drug visits. . . . . 46,034 100.0 

No followup . . . . . . . . . . . . . . . . . . . . . . . 5,228 11.4 

Return at specified time . . . . . . . . . . . . . . 25,998 56.5 

Return if needed . . . . . . . . . . . . . . . . . . . . . 13,640 29.6 

Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,826 6.1 

NOTE: Categories do not add to totals because more than one disposkion 

was recorded for some patients. 

Table 14. Average duration of office visits involving topical 

antimicrobial drugs by type of drug: United States, 1980-81 

Type of topical antimicrobial drug Average duration 

involve d in visit of visit 

Minutes 

All topical antimicrobial drugs. . . . . . . . . . . . . . . . . 13.9 

Ophthalmic antibacterial drugs . . . . . . . . . . . . . . 15.7 

Ophthalmic antibacterial-corticosteroid mixtures. . . 12.7 

Otic drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.7 

Vaginal drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15.8 

Other topical antifungal drugs. . . . . . . . . . . . . . . . 13.3 

Other topical anti- infectives. . . . . . . . . . . . . . . . . . . 14.2 

Other topical anti-infective and corticosteroid 

mixtures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13.0 

Table 15. Numbar and percant distribution of co-occurring 

medications during office visits involving topical antimicrobial 

drugs by therapeutic category United States, 1980-81 

Number of 

drug mentions Percent 

Therapeutic category~ in thousands distribution 

All co-occurring drug mentions . . . . 37,490 100.0 

Anti-infective agents . . . . . . . . . . . . 12,045 32.1 

Skin and mucous membrane 

preparations . . . . . . . . . . . . . . . . . . . . 6,109 16.3 

Central nervous system drugs . . . . . . 3,052 8.1 

Eye, ear, nose, and throat 

preparations . . . . . . . . . . . . . . . . . . . . 2,944 7.9 

Hormones and synthetic substitutes. . . 2,837 7.6 

Antihistamines, . . . . . . . . . . . . . . . . . 2,431 6.5 

Cardiovascular drugs . . . . . . . . . . . . 1,376 3.7 

Vitamins . . . . . . . . . . . . . . . . . . . . . 1,042 2.8 

Electrolytic, caloric, and water 

balance agents.....,........,.. . 985 2.6 

Serums, toxoids, and vaccines . . . . . 966 2.6 

Autonomic drugs . . . . . . . . . . . 933 2.5 

Expectorants and cough 

preparations . . . . . . . . . . . . . . . . . . . . 674 1.8 

Allother2 . . . . . . . . . . . . . . . . . . . . . . . . 2,095 5.6 

lAm erican Hospital Formula~ Service Classification System and Therapeutic


Category Codes. American Society of Hospital Pharmacists, Inc.


‘Includes antineoplastic agents; blood derivatives; blood formation and


coagulation agents; diagnostic agents; enzymes; gastrointestinal drugs gold


compounds; heavy metal antagonists; local anesthetics; oxytocice; radioactive


agents; spasm olytic agents; unclassified therapeutic agenta; devices;


pharmaceutics aids; and undetermined agents.

1

2

3

4

5

6

7

9


a 

The average duration of visits involving topical antimicrobial drugs (shown in table 14) was 13.9 minutes, compared 

‘th 15.5 minutes for all other visits. The shortest visits were 

ose involving otic drugs (11.7 minutes), and the longest were 

those involving vaginal drugs (15. 8 minutes) and ophthalmic 

cntibacten”al drugs (15.7 minutes). 

Co-occurring drugs 

As table 15 shows, there were 37.5 million other drugs 

ordered or provided during visits involving topical antimicrobial 

drugs. This was an average of 0.82 other drugs per visit. Of 

these drug mentions, almost one-third (32. 1 percent) were 

classified in the therapeutic category of anti-infective agents. 

Skin and mucous membrane preparations also accounted for a 

notable proportion (16. 3 percent). 

Only seven specific other drugs reached reliable frequencies. (See table 16.) These accounted for only 13.8 percent of 

all co-occuming drug mentions, reflecting the fact that a wide 

variety of other drugs, rather than a specific few, were utilized 

during topical antimicrobial drug visits. It is noteworthy, however, that all of the leading other drugs are classitled as antiTable 16. Number and percent distribution of the 7 co-occurring 

drugs most frequently mentioned during office visits involving 

topical antimicrobial drugs United States. 1980-81 

Number of 

drug ment!ons Percent 

Rank Name of drug in thousands distribution 

. . . All co-occurring 

medications . . . . . . . . . . . . . 

Ampicillin . . . . . . . . . . . . . . . . 

Tetracycline . . . . . . . . . . . . . . 

Flagyl (metronidazole) . . . . . . 

Erythromycin . . . . . . . . . . . . . . 

Amoxicillin . . . . . . . . . . . . . . . 

Amoxil (amoxicillin) . . . . . . . . 

E.E.S. (erythromycin) . . . . . . . 

. . . Another . . . . . . . . . . . . . . . . . 

37,490 100.0 

1,168 3.1 

862 2.3 

798 2.1 

781 2.1 

624 1.7 

475 1.3 

461 1.2 

32,320 86.2 

infective agents that may be administered systemically. This 

suggests that a high priority in the drug treatment of the cases 

inspected here is a multipronged attack on the infective diseases 

precipitating the visits. 
10 admncedata 

Technical notes 

Source of data and sample design 

The estimates presented in this report are based on the 

findings of the National Ambulatory Medical, Care Survey 

(NAMCS), a sample survey of office-based care conducted 

annually from 1973 through 1981 by the National Center for 

Health Statistics. The target universe of NAMCS is composed 

of office visits made by ambulatory patients to non-Federal 

and noninstitutional physicians who are principally engaged in 

office-based, patient-care practice. Visits to physicians practicing in Alaska and Hawaii are excluded from the range of 

NAMCS, as are visits to anesthesiologists, pathologists, and 

radiologists. 

NAMCS uses a multistage probability sample design that 

involves a step sampling of primary sampling units, physicians’ 

practices within primary sampling units, and patient visits within 

physicians’ practices. The physician sample (5,805 physicians 

for 1980 and 198 1) was selected from master files maintained 

by the American Medical Association and the American 

Osteopathic Association. Those members of the sample who 

proved to be in scope and eligible participated at a rate of 77.3 

percent. Responding physicians completed visit records for a 

systematic random sample of office visits made during a randomly assigned weekly reporting period. Telephone contacts 

were excluded. During 1980 and 1981 responding physicians 

completed 89,447 visit records on which they recorded 97,796 

drug mentions. Characteristics of the physician’s practice, such 

as primary specialty and type of practice, were obtained during 

an induction interview. The National Opinion Research Center, 

under contract to the National Center for Health Statistics, 

was responsible for the field operations of the suwey. 

Sampling errors and rounding 

The standard error is a measure of the sampling variability 

that occurs by chance because only a sample, rather than the 

entire universe, is surveyed. The relative standard error of an 

estimate is obtained by dividing the standard error by the estimate itself and is expressed as a percent of the estimate. In this 

report, any estimate that exceeds a relative standard error of 

30 percent is marked with an asterisk. Table I should be used 

to obtain the relative standard error for aggregates of oftlce 

visits or for mentions of drugs by specific name (for example, 

Darvon). Table II should be used to obtain the relative standard 

error for drug mentions expressed as drug groups (for example, 

the analgesic drug family). 

In this report, the determination of statistical significance 

is based on the Bonferroni modification of the t-test with a 

critical value of 1.96 (0.05 level of significance). Terms relating to differences, such as “higher” or “less,” indicate that the 

differences are statistically significant. Terms such as “similar” 

or “no difference” mean that no statistical significance exists 

between the estimates being compared. A lack of comment in a 

comparison between any two estimates does not mean that the 

difference was tested and was not significant. 

In the tables of this report estimates have been rounded to 

f 

Table 1. Approximate relative standard errors of estimated numbe 

name 

of 

National 

office 

(for 

visits 

Ambulatory 

example, 

and of 

Darvon), 

Medical 

drug mentions 

based 

Care Survey, 

on 

when 

all physician 

drug 

1980-81 

is listed 

specialties: 

by producm

Reletive 

Estimated number of office visits standard 

or specific drug mentions error 

Number in thousands Percent 

“200. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . *44.8 

*BOO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . *3 I .7 

‘450 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . “30.0 

600. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26.0 

800. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22.6 

1,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20.2 

2,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14.5 

5,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9.5 

10,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.1 

20,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.6 

50,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.4 

100,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.9 

200,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.6 

500,000. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.5 

1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4 

EXAMPLE OF USE OF TABLE: An aggregate estimate of 35,000,000 office 

visits has a relative standard error of 5.0 percent or a standard error of 

1,750,000 viaita (5.0 percent of 35,000,000 viaita). 

Table 1I. Approximate relative standard errors of estimated numbe 

of drug mentions when drugs appear in groups (for example, the 

analgesic drug family), based on all physician specialties: NationalQ

Ambulatory Medical Care Survey, 1980-81 

Relative 

Estimated number of standard 

grouped drug mentions error 

Number in thousands Percent 

*54.2 

*38.5 

31.5 

“30.0 

27.3 

24.5 

17.6 

11.6 

8.7 

6.8 

5.3 

4.7 

4.4 

4.2 

4.1 

EXAMPLE OF USE OF TABLE: An aggregate estimate of 30,000,000 drug 

mentions haa a relative standerd error of 7.0 percent or a standard error of 

2,100,000 mentions (7.0 percent of 30,000,000 mentions). 

the nearest thousand. For this reason, detailed estimates do not 

always add to totals. 

Definitions 

An ofice is a place that physicians identify as a location 

for their ambulatory practice. Responsibility for patient care 
---

adwmdaa 11


and professional services rendered in an ofice resides with the 

“ ividual physician rather than an institution. 

~ visit is a direct personal exchange between an ambulatory 

tient seeking health care and a physician, or staff member 

working under the physician’s supervision, who provides the 

health services. 

A drug mention is the physician’s entry on the visit record 

of a pharmaceutical agent ordered or provided by any route of 

administration for prevention, diagnosis, or treatment. Generic 

and brand-name drugs are included as are nonprescription and 

prescription drugs. The physician records all new drugs and all 

continued medications if the patient specifically is instructed 

An acute problem is a morbid condition with a relatively 

sudden or recent onset (within 3 months of the visit). 

A chronic problem is a morbid condition that existed for 3 

months or longer before the visit. The care indicated is of a 

regular, maintenance nature. 

A chronic problem flareup is a sudden exacerbation of a 

preexisting chronic condition. 

Nonillness care denotes health examinations and care 

provided for presumably healthy persons. Examples of nonillness care include prenatal and postnatal care, annual physicals, 

well-child examinations, and insurance examinations. 

w 

during the visit to continue the medication. 

. . . 

0.0 

z 

* 

# 

Symbols 

Data not available 

Category not applicable 

Quantity zero 

Quantity more than zero but less than 

0.05 

Quantity more than zero but less than 

500 where numbers are rounded to 

thousands 

Figure does not meet standard of 

reliability or precision 

Figure suppressed to comply with 

confidentiality requirements 
12


Recent Issues of Advance Data From Wtal and Health Statistics


No. 105. Diagnosis-Related Groups Using Data From the National No. 102. Use of Contraception in the United States: 1982 (Issum


Hospital Discharge Survey: United States, 1982 (Issued 

1985) 

No. 104. Fecundity and Infertility in the United States, 

(Issued Feb. 11, 1985) 

No. 103. Use of Services for Family Planning and Infertility 

States, 1982 (Issued Dec. 20, 1984) 

Suggested Citation 

National Center for Health Statistics, G. Gardocki: 

Use of topical antimicrobial drugs in office-based 

practice, United States, 1980–81. Advance Data 

From Vital and Health Statistics. No. 106. DH HS 

Pub. No. (PHS) 85-1250. Pltblic Health Service, 

Hyattsville, Md., Apr. 10, 1985 

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No. 101. 1983 Summary National Hospital Discharge Survey (Is1965-82 sued Sept. 28, 1984) 

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