Efforts to reduce the use of antibiotics

July 8, 2022

Antibiotic prescribing at ambulatory care clinics was cut almost in half in clinics that participated in a safety program funded by the Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ).

Research published today in JAMA Open Network is the latest demonstration that AHRQ's efforts to help healthcare providers manage their prescribing practices more appropriately can significantly improve antibiotic prescribing.

The study analyzed the results of the AHRQ Safety Program, which assisted 389 ambulatory clinics in establishing or improving antibiotic stewardship programs—coordinated internal programs that promote the appropriate use of antibiotics. Antibiotic prescribing at participating clinics decreased overall by nearly 48 percent, while antibiotic prescribing for acute respiratory infection diagnoses decreased by 37 percent.

"Antibiotics save lives—but we must use them judiciously to reduce the chance of resistance and ensure that they continue to be effective," said AHRQ Director Robert Otto Valdez, Ph.D., M.H.S.A. "This program is an example of what AHRQ does best: examining the evidence and developing interventions to keep patients safe."

Antibiotic medications have drastically reduced illness and death due to bacterial infectious diseases. Millions of antibiotic prescriptions are written annually in the United States, mainly in ambulatory care settings. However, up to half of all prescriptions are medically inappropriate, which can increase the risk of antibiotic resistance developing in microbes, rendering antibiotics useless against them. It is estimated that at least 2.8 million illnesses and 35,000 deaths in the United States each year are caused by antibiotic-resistant bacteria.

The AHRQ Safety Program is based on core concepts from the Agency's signature Comprehensive Unit-based Safety Program and the Four Moments of Antibiotic Decision Making, a clinician-developed framework that simplifies the complex process of antibiotic prescribing. The Four Moments of Antibiotic Decision Making are the critical time periods to assess the need for antibiotics; clinicians can use the framework whenever antibiotics are being considered for treatment.

The new study reviewed data from several types of ambulatory clinics, including primary care, pediatric care, urgent care, federally supported healthcare (such as Federally Qualified Health Centers and Indian Health Services clinics) and student health centers. The decline in antibiotic prescribing was more pronounced in urgent care clinics and pediatric practices.

"The AHRQ Safety Program continues to demonstrate that focusing attention on appropriate prescribing through the Four Moments of Antibiotic Decision Making is effective across care settings," said AHRQ physician Melissa A. Miller, M.D., M.S., co-author of the study.

AHRQ release