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National Ambulatory Antibiotic Stewardship Program Offers Hope in Fight Against Antimicrobial Resistance


  • A national antibiotic stewardship program was associated with declines in antibiotic prescribing in ambulatory settings, such as primary care or urgent care, according to a study presented at IDWeek.
  • Total antibiotic prescribing declined by 9 prescriptions per 100 visits and acute respiratory infection-related antibiotic prescriptions decreased by 15 per 100 visits by program end.
  • The program has the potential to serve as a model for ambulatory practices nationwide, which have traditionally been overlooked in antibiotic stewardship efforts.

A new program to ensure antibiotics are used properly, funded by the Agency for Healthcare Research and Quality (AHRQ), was associated with declines in antibiotic prescribing in ambulatory clinics even in the face of COVID-19 related disruptions, according to results presented at IDWeek.

Researchers at Johns Hopkins Medicine and the NORC at the University of Chicago worked with national experts to create and implement the AHRQ Safety Program for Improving Antibiotic Use. In total, 389 ambulatory practices completed the program nationwide. The program found that total antibiotic prescribing fell significantly, declining by 9 prescriptions per 100 visits, and acute respiratory infection-related antibiotic prescriptions decreased by 15 per100 visits by program end.

“Making sure antibiotics are used properly is a huge challenge,” said Sara Keller, MD, MPH, MSHP, Associate Professor at Johns Hopkins University School of Medicine and presenting author. “We want to ensure that patients who need antibiotics receive the most appropriate medication for the shortest effective duration and to reduce use of antibiotics when they are not needed. This is critical if we are to beat back antimicrobial resistance or AMR.”

The program provides education and technical support to ambulatory care clinicians and staff to improve antibiotic use by incorporating stewardship into practice culture, communication, and decision making. Antibiotic stewardship is a key strategy to combatting AMR, and most antibiotics are prescribed in ambulatory care settings. However, little is known about effective implementation strategies in this setting, as past research has focused largely on acute care settings.

Researchers believe the program could serve as a model for ambulatory practices and will release a toolkit to facilitate nationwide implementation in the coming year.

“We have demonstrated that it is possible to implement stewardship on a large scale in different practices and settings across the country,” said Keller. “To improve antibiotic use is to improve patient safety. There is immense hope in that.”

In addition to Dr. Keller, co-authors of the study include: Tania M. Caballero, MD, MHS; Pranita Tamma, MD, MHS; Melissa A. Miller, MD, MS; Prashila Dullabh, MD; Roy Ahn, MPH, ScD; Savyasachi V. Shah, BDS, MPH; Yue Gao, MPH; Kathleen Speck, MPH; Sara E. Cosgrove, MD, MS; and Jeffrey A. Linder, MD, MPH, FACP

About IDWeek

IDWeek is the joint annual meeting of the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP). IDWeek is a recognized forum for peer-reviewed presentations of new research on scientific advances and bench-to-bedside approaches in prevention, diagnosis, treatment, and epidemiology of infectious diseases, including HIV, across the lifespan. For more information, visit

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