It's about the patients: Practical antibiotic stewardship in outpatient settings in the United States.

Antibiotic-resistant pathogens cause over 35,000 preventable deaths in the United States every year, and multiple strategies could decrease morbidity and mortality. As antibiotic stewardship requirements are being deployed for the outpatient setting, community providers are facing systematic challenges in implementing stewardship programs. Given that the vast majority of antibiotics are prescribed in the outpatient setting, there are endless opportunities to make a smart and informed choice when prescribing and to move the needle on antibiotic stewardship. Antibiotic stewardship in the community, or "smart prescribing" as we suggest, should factor in antibiotic efficacy, safety, local resistance rates, and overall cost, in addition to patient-specific factors and disease presentation, to arrive at an appropriate therapy. Here, we discuss some of the challenges, such as patient/parent pressure to prescribe, lack of data or resources for implementation, and a disconnect between guidelines and real-world practice, among others. We have assembled an easy-to-use best practice guide for providers in the outpatient setting who lack the time or resources to develop a plan or consult lengthy guidelines. We provide specific suggestions for antibiotic prescribing that align real-world clinical practice with best practices for antibiotic stewardship for two of the most common bacterial infections seen in the outpatient setting: community-acquired pneumonia and skin and soft-tissue infection. In addition, we discuss many ways that community providers, payors, and regulatory bodies can make antibiotic stewardship easier to implement and more streamlined in the outpatient setting.

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Copyright © 2022 Amin, Dellinger, Harnett, Kraft, LaPlante, LoVecchio, McKinnell, Tillotson and Valentine.

Déclaration de conflit d'intérêts

AA served as primary or co-investigator of clinical trials sponsored by, NeuroRx Pharma, Pulmotect, Blade Therapeutics, Novartis, Takeda, Humanigen, Eli Lilly, PTC Therapeutics, Octapharma, Fulcrum Therapeutics, and Alexion; and as a speaker and/or consultant for BMS, Pfizer, BI, Portola, Sunovion, Mylan, Salix, Alexion, AstraZeneca, Novartis, Nabriva, Paratek, Bayer, Tetraphase, Achaogen, La Jolla, Ferring, Seres, Millennium, PeraHealth, HeartRite, AseptiScope, and Sprightly. ED served as a consultant for Botanix Pharmaceuticals. BK received research funding from Savara Pharmaceuticals; served on advisory boards for GST Micro and Shionogi Pharmaceuticals; acted as a consultant for Atheneum; and a speaker for Boehringer Ingelheim and La Jolla. KL served as an advisor on grants sponsored by Merck, Pfizer, and as a consultant for Paratek Pharmaceuticals and Ferring Pharmaceuticals. FL served on the speakers’ bureau for AbbVie. GT served as an advisor on grants sponsored by Ferring Pharmaceuticals and Spero Pharmaceuticals, as a consultant for Taro Pharmaceuticals and Provepharm, and participated in a DSMB for Vail Scientific, and was an employee of GST Micro LLC. SV was employed as Vice President by American Family Care. GH was employed by company No Resistance Consulting. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.