Overview of Methods for Assessing Antimicrobial Use in Outpatient Settings in High-Income Countries: A Narrative...

Area of Science:

• Public Health
• Infectious Diseases
• Health Services Research

Background:

• Over 80-90% of antibiotics are prescribed in outpatient settings, presenting complex usage patterns.
• Effective monitoring is crucial for antimicrobial stewardship and surveillance in high-income countries (HICs).

Purpose of the Study:

• To examine outpatient antimicrobial use monitoring in HICs.
• To identify data sources and their relevance for stewardship and surveillance.

Main Methods:

• A narrative review of MEDLINE and Embase databases (inception-2023).
• Inclusion of English-language studies on outpatient antimicrobial use in HICs.
• Supplementation with reference screening, web searches, and expert input.

Main Results:

• 287 studies were identified, with 79 meeting inclusion criteria; most were published after 2000.
• Surveillance databases (dispensing, insurance, GP prescribing, commercial, procurement, networks) were the primary data source (73 studies).
• Surveys were less common (6 studies); AWaRe metrics were increasingly reported in recent studies.

Conclusions:

• Surveillance databases are the predominant method for tracking outpatient antimicrobial use in HICs.
• AWaRe metrics are gaining traction, particularly in prescribing and insurance-based studies.
• Enhanced indicators and technological tools are necessary to bolster antimicrobial stewardship programs.