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Outpatient Antibiotic Stewardship

For Healthcare Professionals

Outpatient stewardship refers to coordinated efforts to promote appropriate prescribing of antibiotics for non-hospitalized patients in clinics, offices, and emergency rooms. Stewardship initiatives can range in size and scope and can be implemented by a variety of stakeholders. Regardless of the clinical setting, the overarching goal is to promote adherence to clinical practice guidelines to provide the best standard of care and to minimize the spread of antibiotic-resistant bacteria.

Fast Facts

Antibiotic use is the most important modifiable driver of antibiotic resistance, and antibiotic-resistant infections lead to higher healthcare costs, poor health outcomes, and more toxic treatments 1.

At least 30% of antibiotic courses prescribed in the outpatient setting are unnecessary, meaning that no antibiotic is needed at all. Most of this unnecessary use is for acute respiratory conditions, such as colds, bronchitis, sore throats caused by viruses, and even some sinus and ear infections 2.

Total inappropriate antibiotic use, which includes unnecessary antibiotic use plus inappropriate antibiotic selection, dosing, and duration, may approach 50% of all outpatient antibiotic use. 3, 5.

Antibiotics are the most common cause of adverse drug events (ADEs) in children, accounting for 7 of the top 10 drugs leading to pediatric ADE-related emergency room (ER) visits.  Antibiotics are in the top three drug classes leading to ADE-related ER visits for all ages. 6.

Improving antibiotic prescribing can reduce harm. A 10% decrease in inappropriate prescribing in the community can result in a 17% reduction in Clostridium difficile infection, a severe form of diarrhea usually caused by antibiotic exposure 7.

References

  1. Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States. 16 September 2013. Web. 17 July 2014.
  2. Fleming-Dutra, K., et al. (2016). “Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011.” JAMA: the Journal of the American Medical Association  315(17): 1864-1873.
  3. Centers for Disease Control and Prevention (CDC). Office-related antibiotic prescribing for persons aged ≤14 years — United States, 1993—1994 to 2007—2008. MMWR Morb Mortal Wkly Rep. 2011;60(34):1153-6.
  4. Pichichero ME. Dynamics of antibiotic prescribing for children. JAMA. June 19, 2002;287(23):3133-5.
  5. Shapiro DJ, Hicks LA, Pavia AT, Hersh AL. Antibiotic prescribing for adults in ambulatory care in the USA, 2007–09. J Antimicrob Chemother. 2014;69(1):234-40.
  6. Shehab, N., et al. (2016). “US emergency department visits for outpatient adverse drug events, 2013-2014.” JAMA 316(20): 2115-2125.
  7. Dantes, R., et al. (2015). “Association Between Outpatient Antibiotic Prescribing Practices and Community-Associated Clostridium difficile Infection.” Open forum infectious diseases 2(3): ofv113-ofv113.

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