Antibiotic Use at Hospital Discharge and Outpatient Antimicrobial Stewardship

Purpose of Review

Inappropriate and unnecessary antibiotic prescriptions are common in the outpatient setting and as patients transition from inpatient to outpatient care. This review is designed to discuss effective strategies aimed to improve appropriate antibiotic use during transitions of care and in the outpatient setting for high-priority syndrome areas including acute respiratory infections (ARI), urinary tract infections (UTI), skin and soft tissue infections (SSTI), and bone and joint infections (BJI).

Recent Findings

Unlike inpatient stewardship programs, outpatient stewardship practices are currently not standardized across many healthcare systems. Since starting an outpatient ASP can be overwhelming, many programs opt to start by focusing on a smaller subset of high-priority locations or syndromes where antibiotics may be inappropriately prescribed. Numerous studies have identified effective antimicrobial stewardship strategies that can be incorporated on transitions of care and in the outpatient setting; however, a multimodal approach combining several stewardship strategies is often cited as the most effective approach. Available syndrome-specific interventions include opportunities at time of diagnosis, order entry, and post-prescription which may be tailored to meet individual program needs.

Summary

Outpatient ASP interventions targeted at diagnostic stewardship, adjustments to duration of therapy, optimization of agent selection, and avoidance of intravenous therapy remain high-priority target areas to prevent inappropriate antibiotic use.