Next Steps in Ambulatory Stewardship

Area of Science:

• Infectious Diseases
• Public Health
• Pharmacology

Background:

• A significant proportion of antibiotic prescriptions, 30-50%, are unnecessary in outpatient settings.
• Inappropriate antibiotic use drives antibiotic resistance and increases patient risk for adverse drug events and Clostridioides difficile infections.

Purpose of the Study:

• To review the current status of antibiotic stewardship in US ambulatory settings.
• To outline best practices for implementing effective ambulatory stewardship programs.
• To identify future directions for optimizing antibiotic utilization in outpatient care.

Main Methods:

• This is a review article, synthesizing current literature and guidelines.
• Discussion of national recommendations for ambulatory antibiotic stewardship.
• Analysis of challenges and facilitators for program implementation.

Main Results:

• Uptake of antibiotic stewardship programs in ambulatory settings has been low despite national recommendations.
• Effective implementation requires tailored strategies addressing unique ambulatory care challenges.
• Key components include guideline dissemination, prescriber education, and performance monitoring.

Conclusions:

• Enhancing antibiotic stewardship in ambulatory settings is critical for antimicrobial resistance containment.
• Successful implementation necessitates addressing barriers to uptake and adopting evidence-based best practices.
• Future efforts should focus on innovative approaches to improve outpatient antibiotic prescribing.