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Outpatient Antibiotic Stewardship Toolkit

Antibiotics can save lives. When a patient needs antibiotics, the benefits outweigh the risks of side effects and antibiotic resistance, but antibiotics aren't always the answer. Everyone can help improve antibiotic prescribing and use. Improving the way healthcare professionals prescribe and the way we take antibiotics will help keep us healthy now, fight antibiotic resistance, and ensure that these life-saving antibiotics will be available for future generations.

In outpatient settings, about 30% of antibiotic prescriptions are unnecessary and even more involve inappropriate selection of antibiotic, dose, and duration of treatment. This toolkit contains resources for outpatient facilities to establish and maintain an antibiotic stewardship program, as well as guidelines for diagnosis and treatment of some common infections encountered in the outpatient setting.

Tools for Strengthening Your Antibiotic Stewardship Program

Strengthening or establishing an antibiotic stewardship program in the outpatient setting requires four core elements: commitment, action for policy and practice, tracking and reporting, and education and expertise.

CDC’s Core Elements guide walks through all four components and discusses strategies to implement each element in practice. Checklists break down actionable items further and can help with planning. Additionally, audit tools are a component of tracking and reporting that can help clinicians and facilities understand ways in which they can improve antibiotic prescribing.

Tools for Commitment to Antibiotic Stewardship

A randomized clinical trial in five outpatient primary care clinics found that displaying personalized public commitment posters in examination rooms resulted in a 19.7% decrease in inappropriate antibiotic prescribing for upper respiratory infections. This low-cost intervention has potential to enhance quality improvement efforts around antibiotic use.

Tools for Appropriate Diagnosis and Treatment of Common Outpatient Infections

A small number of infections account for the majority of antibiotic prescriptions in the outpatient setting. These “target conditions” are key areas where inappropriate antibiotic use can be reduced. For example, 50% of antibiotic prescriptions for outpatient respiratory infections are unnecessary.

Treatment charts include information about epidemiology/etiology, correct diagnosis, and updated treatment guidance from professional organizations. They are meant to guide clinical practice in management of these common conditions. Antibiograms are meant to advise clinical decision making based on local antibiotic resistance patterns.

Tools for Patient Education

Improving antibiotic use is a matter of patient safety. By educating patients about the benefits, dangers, and correct use of antibiotics, they become more empowered in their own health. Where clinically indicated, two strategies to improve antibiotic use are watchful waiting and delayed prescribing. Research has shown that watchful waiting and delayed prescribing do not negatively impact patient outcomes and satisfaction.

These tools provide patient education for the entire care continuum from calling for an appointment to the waiting and exam rooms and prescription pads.