SIDP calls on pharmacists to lead outpatient antibiotic stewardship

Outpatient antibiotic stewardship can develop in various forms 

The Essential Role of Pharmacists in Antibiotic Stewardship in Outpatient Care, a recent position statement published by the Society of Infectious Disease Pharmacists (SIDP), underscores the impact of pharmacy involvement on infection prevention and control. In the face of rapidly evolving regulations, SIDP called upon pharmacists as leaders to design and implement strategies for antibiotic stewardship in outpatient settings. 

Expanding antibiotic stewardship in the community is likely one of the most influential ways to battle the untoward effects of widespread antibiotic misuse, including resistance, superinfection, and medication-related adverse effects. While most antibiotic prescribing occurs in outpatient care, 30%-50% of all prescriptions written in this setting are unnecessary. Even when antibiotics are indicated, the correct drug is only used about one-half of the time.

The incidence of antibiotic resistance in the community has become increasingly common in the literature and has even been reported to exceed that of acute care settings.  Other unintended consequences of antibiotic use, like superinfection, are also hitting closer to home. Clostridium difficile infection, for example, was once considered a hospital-acquired pathogen, but the majority of cases currently occur in the community.  

CDC released an antibiotic stewardship core elements document that focuses on the implementation and structure of outpatient antibiotic stewardship programs, including strategies well suited for pharmacist leadership. SIDP urged that pharmacists need to participate in the development of new and innovative methods of program delivery. 

Outpatient antibiotic stewardship can develop in various forms depending on the setting’s needs and the program’s desired scope. Whereas one model may be similar to an inpatient model, employing the majority of stewardship personnel in a single entity, an alternate model may consist of individuals with common interests in antibiotic stewardship collaborating across organizational lines, institutions, and health care settings within a community. 

Regardless of the model, pharmacists play a unique and essential role in outpatient stewardship because of their knowledge of antimicrobial therapy, particularly the selection of nonantibiotic symptomatic therapy alternatives, pharmacokinetics and pharmacodynamics, adverse effects, and drug–drug interactions. Pharmacists bring value in the development and implementation of stewardship strategies by counseling, providing educational resources, and tracking, reporting, and assessing the effectiveness of services. 

Pharmacists can also tailor site-specific treatment algorithms to accommodate formularies, local resistance patterns, and patient demographics. Community pharmacists are widely accessible and advance patient-related outcomes by administering immunizations, managing chronic diseases, and assisting with healthy lifestyle changes. Their prevalence throughout the community and their effect throughout multiple phases in the continuum of care emphasizes pharmacists as leaders in the effort toward effective antibiotic stewardship.

For the full article, please visit for the December 2018 issue of Pharmacy Today.