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Exploring CDC's New Outpatient Antibiotic Stewardship Program

Hailing antibiotics as miracle medicines with life-saving benefits, the Centers for Disease Control and Prevention (CDC) hosted a webinar informing health professionals about the significance of prescribing them judiciously in outpatient settings. The CDC held the online presentation on November 15, as part of the Get Smart About Antibiotics Week initiative.
In mid-November, the CDC released the “Core Elements of Outpatient Antibiotic Stewardship.” The webinar—which is available on the agency’s website, Tune in to Safe Healthcare: A CDC Webinar Series—provides a framework for prescribing improvements by outpatient clinicians and within facilities that routinely provide outpatient antibiotic treatment. They followed the release of antibiotic stewardship for hospitals and nursing homes in 2014 and 2015, respectively.
“We need to improve antibiotic use across the spectrum of healthcare, and we can’t leave the outpatient setting out of those efforts,” said Katherine Fleming-Dutra, MD, medical officer in the Office of Antibiotic Stewardship within the Division of Healthcare Quality Promotion at the CDC, who led the webinar.
Thanks to antibiotics, “infectious bacterial diseases that were once deadly are now treatable, substantially reducing deaths compared to the pre-antibiotic era,” Dr. Fleming-Dutra noted.
As adjuncts to modern medical advances, antibiotics help make transplants and chemotherapy possible by preventing and treating bacterial infections. “We need them, and we need them to keep working,” said Dr. Fleming-Dutra. “That’s why antibiotic resistance is one of the most pressing public health threats of our time.”  

Antibiotic resistant infections account for two million illnesses and 23,000 deaths each year in the United States, accounting for an estimated $20 billion in excess direct healthcare costs annually, according to the CDC.
Emphasizing the importance of resorting to antibiotics only when necessary, Dr. Fleming-Dutra said that while antibiotic stewardship programs exist traditionally in the inpatient setting, the volume of antibiotic use is much higher in outpatient practice. Based on data from other developed countries, the CDC estimated that 80% to 90% of use occurs in the outpatient setting, illustrating why antibiotic stewardship is also critical to combatting antibiotic resistance.
So, what is antibiotic stewardship? Dr. Fleming-Dutra, who trained as a pediatric-emergency medicine physician, defined it as an “effort to measure antibiotic prescribing, to improve antibiotic prescribing so that antibiotics are only prescribed and used when needed, to minimize misdiagnoses or delayed diagnoses leading to the underuse of antibiotics, to ensure that the right drug, dose and duration are selected when an antibiotic is needed. And antibiotic stewardship is fundamentally about patient safety and delivering high quality healthcare.”
The new guidelines are aimed at outpatient clinicians, clinics, and health systems with an interest in improving antibiotic prescribing and use—from primary and specialty care to emergency departments and urgent care, retail health and dentistry.
At least 30% of antibiotic prescriptions written in the outpatient setting are unnecessary, the CDC estimated. Even among the remaining 70%, inappropriate antibiotic prescribing is still prevalent. Total inappropriate antibiotic prescribing, including unnecessary antibiotic prescribing plus inappropriate selection, dosing and duration is likely much higher, Dr. Fleming-Dutra suspected.
“The primary modifiable driver of antibiotic resistance is antibiotic use,” she said. Even as newer options appear, “resistance is never far behind.” That’s because “bacteria will inevitably find ways of resisting antibiotics developed by humans, which is why aggressive action is needed now to keep new resistance from developing and to prevent the resistance that already exists from spreading.”

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