Core elements of outpatient antibiotic stewardship.
Open accessAbstract
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.
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Enhanced infection control practices, including appropriate catheter use, antibiotic stewardship, and antifungal prophylaxis practices, might be responsible for some of the decreases in candidemia incidence.
“Enhanced infection control practices, including appropriate catheter use to limit catheter-related bloodstream infections (42–44), antibiotic stewardship, and antifungal prophylaxis practices, might be responsible for some of the decreases.”
From Population-Based Active Surveillance for Culture-Confirmed Candidemia — Four Sites, United States, 2012–2016 (2019) · cites this paper as [42]
The Introduction and Background describe antibiotic stewardship as a way to improve prescribing and reduce antibiotic-related harms. They do not connect it to declining candidemia incidence; the paper also does not address catheter use or antifungal prophylaxis as explanations for that decline. (LLM, conf=0.82)
Experimental — accuracy not yet measuredHigher odds of antibiotic exposure among younger patients and among those presenting with respiratory disease may reflect empirical prescribing driven by diagnostic uncertainty or perceived infection risk.
“Higher odds of antibiotic exposure among younger patients and among those presenting with respiratory disease may reflect empirical prescribing driven by diagnostic uncertainty or perceived infection risk 9,42 .”
From Outpatient Antibiotic Prescribing and Stewardship in South India: AnalysisUsing WHO/INRUD Indicators and AWaRe Classification (2026) · cites this paper as [9]
The Background (page unavailable) reports that about 20% of pediatric outpatient visits versus 10% of adult visits result in an antibiotic prescription. Tracking and Reporting (page unavailable) says antibiotics are commonly prescribed for acute bronchitis despite guidelines advising against them. The paper does not establish the claimed higher odds for the cited patient groups or link their prescribing to diagnostic uncertainty or perceived infection risk. (LLM, conf=0.83)
Experimental — accuracy not yet measuredThe Centers for Disease Control and Prevention recommend that outpatient antibiotic stewardship programs include commitment, implementation, tracking, and access to educational resources.
“The Centers for Disease Control and Prevention recommend outpatient antibiotic stewardship programs to include (1) commitment to optimizing antibiotic prescribing and patient safety, (2) implementation action for stewardship policy or practice, (3) tracking prescribing practices through clinician feedback or self-assessment, and (4) access to educational resources and expertise.182”
From Guidelines of care for the management of acne vulgaris (2024) · cites this paper as [182]
Inappropriate antibiotic prescribing contributes directly to antimicrobial resistance.
“Such practices contribute directly to antimicrobial resistance (AMR), which continues to threaten the effectiveness of antiinfective therapy and has reinforced the global importance of antimicrobial stewardship 7-14 .”
From Outpatient Antibiotic Prescribing and Stewardship in South India: AnalysisUsing WHO/INRUD Indicators and AWaRe Classification (2026) · cites this paper as [9]
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Self-citationJohnson, K. M., Dumkow, L. E., Burns, K. W., Yee, M. A., & Egwuatu, N. E. (2019) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofz393 · Cited by 39 · see citing works
High concurrent use of sulfonylureas and antimicrobials with drug interactions causing hypoglycemia
Pilla, S. J., Pitts, S. I., & Maruthur, N. M. (2022) · Journal of Patient Safety · doi:10.1097/pts.0000000000000739 · Cited by 12 · see citing works
Rathinavelu, M., Palani, M., Velavan, V., Rajan, R. A., & Ravishankar, S. (2026) · International Journal of Drug Delivery Technology · doi:10.25258/ijddt.16.41s.15
- Authors
- Sanchez, G. V., Fleming-Dutra, K. E., Roberts, R. M., & Hicks, L. A.
- Affiliations
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Sanchez, Guillermo V.
- Venue
- MMWR. Recommendations and Reports
- Published
- 2016-11-11
- Volume
- 65
- Issue
- 6
- Pages
- 1-12
- ISSN
- 1057-5987 (ISSN-L)
- 1545-8601
- OpenAlex
- W2549623955
- Cited by
- 607
- References
- 72
- Citations by year
- 2026: 47 · 2025: 49 · 2024: 70 · 2023: 55 · 2022: 77 · 2021: 80 · 2020: 80 · 2019: 76 · 2018: 52 · 2017: 20
- FWCI
- 34.35
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- public-domain
- Locations
- MMWR Recommendations and Reports (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Pew Charitable Trusts
- Brigham and Women's Hospital
- Children's Hospital of Philadelphia
- University of Pennsylvania
- Georgetown University
- Soochow University
- Centers for Disease Control and Prevention
- University of Illinois at Urbana-Champaign
- Perelman School of Medicine, University of Pennsylvania
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Health Sciences › Medicine › Surgery › Surgical site infection prevention
- Keywords
- antibiotic prescribing, prescribing patterns, clinician education, patient and family education, antimicrobial resistance, outpatient clinics
- MeSH terms
- Ambulatory Care Facilities, Anti-Bacterial Agents, Bacterial Infections, Centers for Disease Control and Prevention, U.S., Humans, United States, Practice Guidelines as Topic, Drug Resistance, Bacterial, Inappropriate Prescribing
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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