Association Between Outpatient Antibiotic Prescribing Practices and Community-Associated Clostridium difficile Infection

Core Elements of Outpatient Antibiotic Stewardship

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. In 2014 and 2015, respectively, CDC released the Core Elements of Hospital Antibiotic Stewardship Programs and the Core Elements of Antibiotic Stewardship for Nursing Homes. Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing involves implementing effective strategies to modify prescribing practices to align them with evidence-based recommendations for diagnosis and management. The four core elements of outpatient antibiotic stewardship are commitment, action for policy and practice, tracking and reporting, and education and expertise. Outpatient clinicians and facility leaders can commit to improving antibiotic prescribing and take action by implementing at least one policy or practice aimed at improving antibiotic prescribing practices. Clinicians and leaders of outpatient clinics and health care systems can track antibiotic prescribing practices and regularly report these data back to clinicians. Clinicians can provide educational resources to patients and families on appropriate antibiotic use. Finally, leaders of outpatient clinics and health systems can provide clinicians with education aimed at improving antibiotic prescribing and with access to persons with expertise in antibiotic stewardship. Establishing effective antibiotic stewardship interventions can protect patients and improve clinical outcomes in outpatient health care settings.

Outpatient Antibiotic Prescribing Among United States Nurse Practitioners and Physician Assistants

We examined US nurse practitioner (NP) and physician assistant (PA) outpatient antibiotic prescribing. Antibiotics were more frequently prescribed during visits involving NP/PA visits compared with physician-only visits, including overall visits (17% vs 12%, P < .0001) and acute respiratory infection visits (61% vs 54%, P < .001). Antibiotic stewardship interventions should target NPs and PAs.

Can Improving Knowledge of Antibiotic-Associated Adverse Drug Events Reduce Parent and Patient Demand for Antibiotics?

Background:

According to the Centers for Disease Control and Prevention, at least 2 million people are infected and 23,000 die each year in the United States as a result of antibiotic-resistant bacterial infections. Antibiotic use is the most important factor contributing to antibiotic resistance and overuse is common, especially for upper respiratory tract infections. There is a perception among the public, as well as some health care providers, that antibiotics are harmless. We conducted formative research to explore patient and parent knowledge and attitudes relating to antibiotic use and adverse drug events (ADEs).

Methods:

Six computer-assisted telephone focus groups were conducted in October and November 2010 with adult patients and mothers of young children. The focus groups were developed to engage participants in discussion about their knowledge and attitudes regarding antibiotic resistance and ADEs associated with antibiotic use.

Results:

Nearly all mothers were familiar with the possibility of “side effects” with prescription medications, including antibiotics. However, very few mothers were familiar with severe antibiotic-associated ADEs and nearly all felt strongly that this information should be shared with parents at the time a prescription is recommended or written for their child. Adult participants did not believe that the potential for ADEs was a significant issue for adults and most reported never discussing the potential for adverse events with their provider.

Conclusions:

Parents were receptive to appropriate antibiotic use messaging around ADEs. We learned that ADE messages did not resonate with adults in the same way they did with mothers of young children.