Guiding Antibiotic Stewardship Programs in an Outpatient Setting

A significant leading threat to public health safety around the world has been the growing of antibiotic resistance. Research has found that around half of current antibiotic prescriptions were unnecessary or inappropriate in the outpatient setting.

Recently, investigators from the University of Texas’ Health Science Center McGovern Medical School conducted a multimodal assessment to aid antibiotics stewardship program activities and interventions.

The data was presented at the 2021 Association for Professionals in Infection Control and Epidemiology conference virtual sessions.

For the assessment, the team of investigators developed a patient and provider survey which assessed knowledge, attitude, and behavior towards antibiotics.

To assess antibiotic use pre- and post-intervention for a 6-month period, investigators provided a verbal education and a flow chart to providers in 2 clinics describing the 2010-IDSA/ESCMID guidelines for treatment of uncomplicated cystitis.

Findings from the assessment showed that of the 85 participants who took the patient survey, 38% recognized the relationship between over usage and the emergence of antibiotic-resistant organisms.

Additionally, 17% felt that they were wasting their time if they go to a doctor with an infection and they were not prescribed an antibiotic and 86% said they wanted to learn more about antibiotics.

In the provider surveys, participants chose guideline-appropriate treatment for acute uncomplicated cystitis 56% of the time, and 44% of the time for uncomplicated pyelonephritis.

The pre-intervention saw 24 patients (65%) receive an antibiotic with a guideline concordant dose, duration, and frequency. In the post-intervention, 12 patients (32%) received a longer duration than recommended.

“There is an unmet need to address patient and provider knowledge deficits and behaviors towards antibiotics,” the authors wrote. “Future projects will need to include a more active approach to antibiotic stewardship in order to engage both patients and providers.”