Guide: Starting an Outpatient Antibiotic Stewardship Program

Diseases due to bacteria resistant to the antibiotics available are increasing at an alarming rate. Use of antibiotics by humans rose by 40% between 2000 and 2010, but the rate of new antibiotic development has slowed. Recent estimates of the burden of antimicrobial resistance suggest that there are approximately 700,000 deaths worldwide every year due to infections with antimicrobial resistant bacteria, with nearly 50,000 of these deaths occurring in the United States and Europe. A report led by economist Jim O’Neil on antimicrobial resistance commissioned by the British government in 2014 projected that the number of annual deaths attributable to antimicrobial resistance would surpass 10 million by the year 2050 if no meaningful interventions occur. These estimates suggests that death related to antimicrobial resistant infections will surpass cancer as the number one cause of mortality worldwide. (O’Neil, J. Review on Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations. (2014).)

Antibiotic treatment for a single outpatient infection has been shown to influence resistance patterns of future infections. (Paschke AA et al, “Previous antimicrobial exposure is associated with drug-resistant UTI in children”; Pediatrics 2010; 125: 664-672.); Kuster SP et al, “Previous Antibiotic Exposure and Antimicrobial Resistance in Invasive Pneumococcal Disease: Results From Prospective Surveillance,” Clin Infect Dis 2014; 59(7): 944-952.

Prominent examples of increasing antibiotic resistance threats commonly encountered in the outpatient pediatrics setting include:

Streptococcus pneumoniae

Staphylococcus aureus

  • (Tamma PD, Robinson GL, Gerber JS, Newland JG, DeLisle CM, Zaoutis TE, Milstone AM. Pediatric Antibiotic susceptibility trends across the United StatesInfect Control Hosp Epidemiol. 2013 Dec;34(12):1244-51.)
    • A pooled pediatric antibiogram representing 200 pediatric healthcare institutions across the United States from 2005 and 2011 demonstrated that 50% of all Staphylococcus aureus isolates were methicillin-resistant and 21% of S. aureus isolates were resistant to clindamycin.

ESBL-Producing Enterobacteriaceae in Children

See the Antibiotic Resistance page for more information.