Overuse of antibiotics drives the emergence and spread of antimicrobial-resistant organisms, which pose a major threat to public health. 1 Globally, 85% to 95% of human antibiotics consumed are prescribed in outpatient settings such as family practice clinics and urgent care facilities. 2 The majority of non–guideline adherent, or inappropriate, antibiotic prescribing at these sites is for patients with self-limiting upper respiratory tract infections (URTIs), for which antibiotics confer marginal clinical benefit. 3, 4 When antibiotics provide little or no benefit, the risk of antibiotic-related harms far outweigh the potential benefits. 5, 6 Curtailing inappropriate antibiotic prescribing for patients with URTI is necessary to reduce harm and to slow the development of antimicrobial-resistant organisms.
Full Answer
Is antibiotic prescribing in the outpatient setting appropriate?
Antibiotic prescribing in the outpatient setting varies by state. 1 Performance on quality measures for appropriate outpatient antibiotic prescribing varies both by region and health plan. 6 Local outpatient prescribing practices contribute to local resistance patterns. 7 Outpatient antibiotic prescribing is greatest in the winter months. 8
What drives antibiotic prescribing for urinary tract infections (UTIs)?
This finding is surprising given that patients’ expectations to receive antibiotics are stated to be the main driver of antibiotic prescribing for URTIs.7,18It is possible that participants tended to provide socially desirable responses on the questionnaires but made their real expectations clear in the consultation with the family practitioner.
Why outpatient outpatient antibiotic stewardship?
Outpatient settings remain a crucial component of antibiotic stewardship in the United States. Establishing effective antibiotic stewardship interventions can protect patients and optimize clinical outcomes in outpatient health care settings.
What is measuring outpatient antibiotic prescribing?
Measuring Outpatient Antibiotic Prescribing Monitoring of outpatient antibiotic prescribing data is regularly conducted to analyze national and state antibiotic prescribing data in order to better understand trends in outpatient antibiotic prescribing, to identify where interventions to improve prescribing are most needed, and to measure progress.
When do you give antibiotics for URTI?
Antibiotic use should be reserved for moderate symptoms that are not improving after 10 days or that worsen after five to seven days, and severe symptoms. When to treat with an antibiotic: S. pyogenes (group A streptococcus infection). Symptoms of sore throat, fever, headache.
Do upper respiratory infections require antibiotics?
Antibiotics are rarely needed to treat upper respiratory infections and generally should be avoided unless the doctor suspects a bacterial infection. Simple techniques, such as proper handwashing and covering the face while coughing or sneezing, may reduce the spread of respiratory tract infections.
What is the drug of choice for upper respiratory tract infection?
The recommended first-line treatment is a 10-day course of penicillin. Erythromycin can be used in patients who are allergic to penicillin. Amoxicillin, azithromycin (Zithromax), and first-generation cephalosporins are appropriate alternatives.
What antibiotic is good for upper respiratory infection?
Amoxicillin is the preferred treatment in patients with acute bacterial rhinosinusitis. Short-course antibiotic therapy (median of five days' duration) is as effective as longer-course treatment (median of 10 days' duration) in patients with acute, uncomplicated bacterial rhinosinusitis.
When do you need an antibiotic for a cold?
You may need an antibiotic if you have one of the infections listed below. You have a sinus infection that doesn't get better in 10 days. Or it gets better and then suddenly gets worse. You have a fever of 102° F accompanied by facial pain for 3 or more days in a row, possibly with discolored, thick mucus.
When do you need an antibiotic for a sinus infection?
Typically, antibiotics are needed when: Sinus infection symptoms last over a week. Symptoms worsen after starting to get better. Sinusitis symptoms are severe (high fever, skin infection or rash, extreme pain or tenderness around the eyes or nose)
What is the first line treatment for upper respiratory infection?
The first-line treatment is amoxicillin (50 mg/kg/day for 10 days). In non-compliant cases, cefaclor (40 mg/kg/day) or cefuroxime-axetil (20-30 mg/kg/day) may be administrated [10]. Epiglottitis is a supraglottic laryngitis. It may be caused by S.
Which antibiotic is best for throat and chest infection?
Amoxycillin, or alternatively erythromycin, will usually be suitable. In any patient, of any age, with a lower respiratory infection, the presence of new focal chest signs should be treated as pneumonia and antibiotic therapy should not be delayed.
Is azithromycin good for respiratory infection?
Azithromycin is not only effective against most common upper respiratory bacterial pathogens such as group A streptococci, S. pneumoniae, H. influenzae and M. catarrhalis but also has a good safety profile [1].
Why azithromycin is given for 3 days?
It is concluded that a 3-day regimen of azithromycin prescribed as tablets is as clinically and microbiologically effective as a 10-day regimen of co-amoxiclav in the treatment of acute lower respiratory tract infections.
How much of antibiotics are unnecessary in the outpatient setting?
At least 30% of antibiotics prescribed in the outpatient setting are unnecessary, meaning that no antibiotic was needed at all. 2. Total inappropriate antibiotic use, inclusive of unnecessary use and inappropriate selection, dosing and duration, may approach 50% of all outpatient antibiotic use. 3, 4, 5. Antibiotic prescribing in the outpatient ...
What is appropriate antibiotic prescribing?
Appropriate antibiotic prescribing means antibiotics are only prescribed when needed, and when needed, the right antibiotic is selected and prescribed at the right dose and for the right duration. Appropriate antibiotic prescribing should be in accordance with evidence-based national and local clinical practice guidelines, when available.
How much of antibiotics are unnecessary?
CDC estimates that at least 30% of antibiotics prescribed in the outpatient setting are unnecessary, meaning that no antibiotic was needed at all. 2 Total inappropriate antibiotic use, inclusive of unnecessary use and inappropriate selection, dosing and duration, may approach 50% of all outpatient antibiotic use. 3, 4, 5.
What is the most commonly prescribed antibiotic?
An estimated 80-90% of the volume of human antibiotic use occurs in the outpatient setting. 10, 11. Azithromycin and amoxicillin are among the most commonly prescribed antibiotics. 1.
How many antibiotics were dispensed in 2014?
In 2014, 266.1 million courses of antibiotics are dispensed to outpatients in U.S. community pharmacies. This equates to more than 5 prescriptions written each year for every 6 people in the United States. 1. At least 30% of antibiotics prescribed in the outpatient setting are unnecessary, meaning that no antibiotic was needed at all. 2.
Summary
The Core Elements of Outpatient Antibiotic Stewardship provides a framework for antibiotic stewardship for outpatient clinicians and facilities that routinely provide antibiotic treatment. This report augments existing guidance for other clinical settings.
Introduction
Antibiotic resistance is among the greatest public health threats today, leading to an estimated 2 million infections and 23,000 deaths per year in the United States.
Background
Improving antibiotic prescribing in all health care settings is critical to combating antibiotic-resistant bacteria. 7 Approximately 60% of U.S. antibiotic expenditures for humans are related to care received in outpatient settings. 8 In other developed countries, approximately 80%–90% of antibiotic use occurs among outpatients.
Methods
CDC’s Core Elements of Outpatient Antibiotic Stewardship were developed through a combination of consolidating evidence-based antibiotic stewardship practices and building on or adapting known best practices for antibiotic stewardship across other clinical settings, such as the core elements outlined for hospitals 21,22 and nursing homes.
Core Elements of Outpatient Antibiotic Stewardship
The Core Elements of Outpatient Antibiotic Stewardship follow and are summarized in a clinician checklist pdf icon [PDF – 2 pages] and a facility checklist pdf icon [PDF – 2 pages].
Commitment
A commitment from all health care team members to prescribe antibiotics appropriately and engage in antibiotic stewardship is critical to improving antibiotic prescribing. Every person involved in patient care, whether directly or indirectly, can act as an antibiotic steward.
Action for Policy and Practice
Outpatient clinicians and clinic leaders can implement policies and interventions to promote appropriate antibiotic prescribing practices. A stepwise approach with achievable goals can facilitate policy and practice changes and help clinicians and staff members from feeling overwhelmed.
What are the symptoms of a viral URI?
Worsening symptoms: worsening or new onset fever, daytime cough, or nasal discharge after initial improvement of a viral URI. Severe symptoms: fever ≥39°C, purulent nasal discharge for at least 3 consecutive days. Imaging tests are no longer recommended for uncomplicated cases. If a bacterial infection is established:
What is the most common childhood infection for which antibiotics are prescribed?
AOM is the most common childhood infection for which antibiotics are prescribed. 4-10% of children with AOM treated with antibiotics experience adverse effects. 4. Definitive diagnosis requires either. Moderate or severe bulging of tympanic membrane (TM) or new onset otorrhea not due to otitis externa.
How long can you wait to take amoxicillin for a child?
Mild cases with unilateral symptoms in children 6-23 months of age or unilateral or bilateral symptoms in children >2 years may be appropriate for watchful waiting based on shared decision-making. Amoxicillin remains first line therapy for children who have not received amoxicillin within the past 30 days.
What antibiotics should I take for sinusitis?
Antibiotic therapy should be prescribed for children with acute bacterial sinusitis with severe or worsening disease. Amoxicillin or amoxicillin/clavulanate remain first-line therapy. Recommendations for treatment of children with a history of type I hypersensitivity to penicillin vary. 1, 2. In children who are vomiting or who cannot tolerate oral ...
How long does it take to treat bacteriuria in a child?
Duration of therapy should be 7-14 days in children 2-24 months. Antibiotic treatment of asymptomatic bacteriuria in children is not recommended.
What is urine lysis?
Urinalysis is suggestive of infection with the presence of pyuria (leukocyte esterase or ≥5 WBCs per high powered field), bacteriuria, or nitrites. Nitrites are not a sensitive measure for UTI in children and cannot be used to rule out UTIs.
How long does it take for atypical disease to improve?
Usually patients worsen between 3-5 days, followed by improvement.