Reducing antibiotic resistance through antibiotic stewardship in the ambulatory setting

Abstract

The struggle against antibiotic resistance has never been more pressing. In the USA alone, antibiotic-resistant bacteria cause more than 2 million infections and 23 000 deaths yearly. 1 US Centers for Disease Control and PreventionAntibiotic/antimicrobial resistance (AR/AMR). http://www.cdc.gov/drugresistanceDate: 2019 Date accessed: September 28, 2019 Google Scholar Between 60% and 90% of human antibiotic consumption globally occurs in the outpatient setting, and at least a third of antibiotics prescribed in ambulatory care settings are not necessary. 2 Sanchez GV Fleming-Dutra KE Roberts RM Hicks LA Core elements of outpatient antibiotic stewardship. MMWR Morb Mortal Wkly Rep. 2016; 65: 1-12 PubMed Google Scholar Improving antibiotic stewardship in ambulatory settings is therefore integral to counteracting antibiotic resistance. Few studies propose methods for implementing successful and sustainable antibiotic stewardship activities in ambulatory settings. By contrast with acute care settings, this area of practice has unique challenges for stewardship, including insufficient resources for quality-improvement infrastructure, the absence of team-delivered care, evaluation of patients at a single timepoint, time constraints limiting detailed discussions with patients, and a larger component of prescribing on the basis of perceived or real patient demand. Long-term impact of an educational antimicrobial stewardship programme in primary care on infections caused by extended-spectrum β-lactamase-producing Escherichia coli in the community: an interrupted time-series analysisOur data suggest that implementation of a multimodal ASP in primary care that is based on individual educational interviews improves the use of antibiotics and results in a sustained significant reduction of infections by ESBL-producing E coli in the community. This information should encourage the implementation of ASPs in primary care. Full-Text PDF