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Antimicrobial Stewardship: Resources for Health Care Providers

Five medical professionals are smiling.

Understanding the basic tenets of antimicrobial prescribing is critical for all health care providers prescribing and managing antibiotics for patients. While antibiotics can be beneficial for patients with bacterial infections, they are not effective for treating viral or fungal infections. Side effects from antibiotics, such as affecting other bacteria in the body or adverse reactions, are common. Furthermore, overprescribing of antibiotics has led to a worldwide problem with antibiotic-resistant bacteria. Antimicrobial resistance can lead to difficulties in treating a patient’s condition and sometimes serious, life-threatening illness.

Oversight of antimicrobial prescribing, through antimicrobial stewardship (AS) programs, is essential to help guide the benefits and risks of antimicrobial treatment. AS programs combine data review and prescriber education to reinforce evidence-based practices among clinicians and more effective use of antibiotics. Several national organizations, including CMS (Centers for Medicaid & Medicare Services), have mandated that hospitals and nursing homes implement AS programs. Many stewardship programs utilize CDC’s (Centers for Disease Control and Prevention) Core Elements of Antibiotic Stewardship as a roadmap.

  Join a stakeholder group

Are you a health care provider interested in contributing to antimicrobial stewardship efforts in Wisconsin? There are currently two active stakeholder groups open to health care providers: Wisconsin Antimicrobial Stewardship Steering Committee, and the Wisconsin Community Hospital stakeholder group. Contact the Healthcare-Associated Infections (HAI) Prevention Program’s Antimicrobial Stewardship Coordinator, Dr. Lindsay Taylor, for more information.

Resources by setting

Read setting-specific information, statistics, and resources for health care providers by expanding the tabs below.

General medical conditions continue to grow more complex over time, causing patients to become hospitalized with complicated care. There is also a rising trend of elderly patients admitted to the hospital with multiple medical problems. Surveys have shown that 50% of all hospitalized patients receive an antibiotic during their stay. Per the CDC, about 30% of all antibiotics prescribed in US acute care hospitals are either unnecessary or suboptimal. In Wisconsin, 100% of acute care hospitals reported adopting all seven inpatient core elements in 2022.

Resources for inpatient providers

In recent years, an increasing numbers of residents have been admitted to long-term care facilities (LTCFs) with complicated conditions. Some types of care and treatments that may have been provided in an inpatient setting years ago are now provided in nursing homes or assisted living facilities. Per the CDC, antibiotics are among the most frequently prescribed medications in nursing homes, with up to 70% of residents receiving one or more antibiotic courses per year. Yet, studies have shown that 40–75% of antibiotics prescribed in nursing homes may be unnecessary or inappropriate.

While not all nursing homes in Wisconsin report these data, in both 2021 and 2022, 72% of nursing homes reporting these data indicated that they had adopted all seven nursing home AS core elements. You can learn more about efforts to promote antibiotic stewardship in LTCF by visiting the HAIs in LTC Coalition webpage.

Resources for long-term care providers

Eighty to ninety percent of the volume of human antibiotic use occurs in the outpatient setting. Per the CDC, at least 30% of antibiotics prescribed in U.S. doctors’ offices and emergency departments are unnecessary. The majority of infectious disease conditions in the outpatient setting are caused by viral infections for which antibiotics have no effect.

Antibiotic stewardship efforts in the outpatient setting help balance the need for effective treatment of bacterial infections while reducing prescribing for viral illnesses. Many providers around the state of Wisconsin are tracking current prescribing practices and offering targeted education to further advance this important initiative.

To better understand the current state of outpatient antibiotic use in Wisconsin, the DHS HAI Prevention Program partnered with the Wisconsin Health Information Organization (WHIO) to develop a series of outpatient antibiotic use measures. The Trends in Outpatient Antibiotic Prescribing in Wisconsin 2018–2021, P-03383 (PDF) report uses these measures to describe trends in outpatient antibiotic use and identify additional targets for improvement.

Resources for outpatient providers

Several dental studies noted findings of up to 85% of antibiotic prescriptions as “suboptimal” or “not indicated.”

Dentists also account for 1 in 10 antibiotic prescriptions in the outpatient setting, which makes them the third to fourth highest antibiotic prescribers by volume following family medicine, internal medicine, and pediatrics.

The scope of antibiotic prescribing and use in the dental setting makes it an ongoing area of focus for antibiotic use tracking and evidence-based prescribing reduction.

Resources for dental and oral health providers

The right drug, right dose, de-escalation of therapy, and duration of therapy are all important concepts in establishing a successful AS practice. Pharmacists are trained in optimizing drug regimens and potential adverse effects, making them key members of AS activities across all areas where antibiotics are prescribed. Drug expertise is a component across all the AS core elements.

Resources for pharmacists

Achieving Core Measure Success in the Community Pharmacy Setting: Watch the educational video on improving AS in the pharmacy setting from the Lake Superior Quality Innovation Network.

Resources for providers in any setting

Resources for medical and veterinary students

Find educational information on AS for future health professionals.

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Last revised December 4, 2023