CDC Publishes New Resource: Core Elements of Outpatient Antibiotic Stewardship

Improving antibiotic use is critical to combating antibiotic-resistant bacteria,1 an important global public health problem. The CDC estimates that at least 30% of outpatient antibiotic prescriptions in the United States are completely unnecessary,2 illustrating why antibiotic stewardship is needed in outpatient settings. Antibiotic stewardship refers to the efforts aimed at improving and measuring antibiotic prescribing so that antibiotics are only used when needed; thus ensuring that the right drug, dose, and duration are selected, and minimizing misdiagnoses or delayed diagnoses, leading to underuse of antibiotics where they are needed.3,4 The CDC has now published the Core Elements of Outpatient Antibiotic Stewardship in the Morbidity and Mortality Weekly Report (MMWR): Recommendations and Reports, on November 11, to provide guidance for antibiotic stewardship in outpatient settings. These Core Elements apply to clinics and clinicians in primary care, medical specialties and subspecialties, emergency departments, retail health and urgent care settings, and dentistry.

There are 4 Core Elements:
  1. Commitment—to demonstrate dedication to and accountability for optimizing antibiotic prescribing and patient safety;
  2. Action for Policy and Practice—to implement at least one policy or practice to improve antibiotic prescribing, assess whether it is working, and modify as needed;
  3. Tracking and Reporting—to monitor antibiotic prescribing practices and offer regular feedback to clinicians or have clinicians assess their own antibiotic use;
  4. Education and Expertise—to provide educational resources to clinicians and patients on antibiotic prescribing, and ensure access to needed expertise on antibiotic prescribing.

The Core Elements provide a framework for improving prescribing. It may be helpful to use the Core Elements with other quality improvement initiatives. For every unique outpatient facility, it is important to identify high-priority conditions that represent opportunities for improvement, to identify barriers to improving antibiotic use, and to establish clear evidence-based standards for antibiotic prescribing.
To view the Core Elements and learn more about antibiotic stewardship, please visit:

1. Seppälä H, Klaukka T, Vuopio-Varkila J, et al; Finnish Study Group for Antimicrobial Resistance. The effect of changes in the consumption of macrolide antibiotics on erythromycin resistance in group A streptococci in Finland. N Engl J Med. 1997;337:441446.
2. Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among U.S. ambulatory care visits, 2010-2011. JAMA. 2016;315:18641873.
3. CDC. Antibiotic resistance threats in the United States, 2013. Atlanta, GA: US Department of Health and Human Services, CDC; 2013.
4. Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62:e51–77
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