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February 9, 2016

Improving Outpatient Antibiotic PrescribingAnother Nudge in the Right Direction

Author Affiliations
  • 1Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 2Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
JAMA. 2016;315(6):558-559. doi:10.1001/jama.2016.0430

More than 250 million outpatient antibiotic prescriptions are written in the US each year,1 most of which are for acute respiratory tract infections. A large proportion of these prescriptions are unnecessary.2

Antibiotic overuse leads to unnecessary adverse drug effects and antimicrobial-resistant infections, which harm patients. To address this threat, professional organizations and regulatory agencies have called for acute care hospitals to establish antimicrobial stewardship programs, which are quality improvement and patient safety initiatives to optimize antimicrobial use.3 The vast majority of antibiotic use, however, occurs in the outpatient setting, mostly in internal medicine, family practice, pediatric, and dental offices,1 where there is virtually no formal antimicrobial stewardship. In addition, although the most resistant organisms usually involve infections among hospitalized patients, difficult-to-treat infections such as methicillin-resistant Staphylococcus aureus and extended-spectrum beta lactamase–producing Enterobacteriaciae are now commonly isolated from community-onset infections. Thus, adapting the principles of antimicrobial stewardship to the ambulatory setting should be prioritized.

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