Antibiotic Stewardship: Improving Use In The Community

Antibiotic stewardship is the effort to improve antibiotic prescribing so that antibiotics are used correctly - and only when needed. It includes monitoring antibiotic prescribing; avoiding unnecessary use; minimizing underuse due to missed or delayed diagnoses; and, when an antibiotic is needed, ensuring selection of the appropriate drug, dose, route of administration, and duration of therapy. The goal of antibiotic stewardship is to treat infections effectively, while minimizing unintended consequences of antibiotic use. These include side effects (eg, antibioticassociated diarrhea, especially that caused by Clostridium difficile infection) and the emergence of antibiotic resistance.

Despite the growing problem of antibiotic resistance, FDA approval of new antibiotics declined by about 80% between 1983 and 2012, providing fewer new treatments for drug-resistant bacterial infections. The emergence of antibiotic resistance cannot be stopped; however, the pace at which it evolves can be slowed. Antibiotic overuse and inappropriate use are important modifiable behaviors that contribute to resistance. In the US, the majority of antibiotic use occurs in the community, and a substantial percentage of these prescriptions are inappropriate. An estimated 30% of outpatient antibiotic prescriptions in the US are unnecessary.

National organizations, including the White House and the CDC, recognize the threat posed by antibiotic resistance and have committed to several strategies to combat it. In 2015, the White House released the "National Action Plan for Combating Antibiotic-Resistant Bacteria" (CARB), laying the foundation for collaborative action among various groups and individuals worldwide. A major goal is that, by 2020, aggressive action by all those involved will improve antibiotic use across all US healthcare settings.