Outpatient antibiotic stewardship

What it is

Outpatient antibiotic stewardship is the work a primary care practice does so that antibiotics are used only for appropriate indications. Its core elements are commitment, action for policy and practice, tracking and reporting, and education and expertise. In a primary care community health center the medical director may identify antibiotic stewardship as a priority and communicate with all clinical and administrative staff members to express a consistent message to patients about appropriate indications for antibiotic use.

How it is diagnosed

A procalcitonin-guided therapy algorithm helps decide whether an acute respiratory infection in an adult is bacterial. Using such an algorithm reduces antibiotic use by 3.47 days without increasing either morbidity or mortality. The levels are read as follows.

• Below 0.10 mg/dL a bacterial infection is highly unlikely and it is strongly recommended that antibiotics not be prescribed.
• From 0.10 to 0.24 mg/dL a bacterial infection is still unlikely and it is recommended that antibiotics not be used.
• From 0.25 to 0.50 mg/dL a bacterial infection is likely and antibiotics are recommended.
• Above 0.50 mg/dL a bacterial infection is very likely and it is strongly recommended that antibiotics be given.