CDC Core Elements of Outpatient Antibiotic Stewardship

All members of the healthcare team demonstrate a commitment to appropriate prescribing of antibiotics.

  • Commitment letter
  • Communicate with all clinic staff members to set patient expectations
    • In order to communicate consistent messaging, all clinic staff members including administrative staff, medical assistants, nurses, and clinicians should be included in antibiotic stewardship efforts in order to communicate consistent messaging in setting patient expectations.
  • Identify a single leader
  • Include antibiotic stewardship-related duties in position descriptions or job evaluation criteria
  • Economic incentives

Use Evidence-based Diagnostic Criteria and Treatment Recommendations

Use Delayed Prescribing Practices or Watchful Waiting, When Appropriate

Communication Skills Training for Clinicians

Providing Feedback to Prescribers


  • Proportion of viral acute respiratory tract infections receiving antibiotics
    • HEDIS measure for reimbursement evaluates the number of URIs not receiving an antibiotic
  • Proportion of Streptococcal pharyngitis receiving broad spectrum antibiotics
  • Group A streptococcus pharyngitis must have a rapid antigen strep test with treatment
    • HEDIS measure for reimbursement
    • Over testing has become a problem with many children with rhinorrhea and cough being tested.
  • Proportion of acute otitis media, sinusitis, or community-acquired pneumonia receiving broad spectrum antibiotics
  • Duration of therapy
  • Adverse drug events
  • Incidence of C. difficile infections
  • Revisit rate for acute respiratory tract infections