Antibiotic Stewardship

The Allegheny County Health Department encourages all healthcare professionals to utilize antibiotic stewardship practices to help prevent the overuse of antibiotics.

Antibiotics are critical medications that need to be used judiciously to maintain effectiveness. The CDC reports that about 30% of antibiotics prescribed at acute care hospitals are unnecessary or suboptimal. Misuse of antibiotics leads to resistance and places more people at risk for adverse events and C. difficile infections. 

The Centers for Disease Control and Prevention (CDC) recommends that all hospitals and nursing homes implement the Core Elements of Antibiotic Stewardship to improve antibiotic prescribing practices and reduce the threat of antimicrobial resistance:

• Leadership Commitment: get buy in for obtaining necessary human, financial, and information technology resources.
• Accountability: name a single leader or co-leaders to be responsible for program outcomes. Experience with successful programs show that a physician leader is effective.
• Pharmacy Expertise: use an infectious-disease trained pharmacist as leader or co-leader of the program.
• Action: implement prospective audit and feedback and preauthorization to start, given they have been shown to be the two most effective stewardship interventions in hospitals.
• Tracking: develop both process and outcome measures
• Reporting: disseminate information on antibiotic use and resistance patterns to doctors, nurses and relevant staff
• Education: pair with specific interventions and outcomes

Antibiotic use

The CDC monitors antibiotic use at inpatient facilities through the National Healthcare Safety Network's (NHSN) Patient Safety Component Antimicrobial Use and Resistance (AUR) Antimicrobial Use (AU) Option. Outpatient oral antibiotic prescriptions are tracked using data on retail pharmacy prescriptions and prescription drugs provided to Medicare beneficiaries enrolled in Part D (prescription drug coverage).  CDC reports that in the U.S. there were 756 retail pharmacy antibiotic prescriptions per 1,000 population in 2023 (Outpatient Antibiotic Use: Retail Pharmacy Prescription Data | A.R. & Patient Safety Portal) and 1,211 antibiotic prescriptions per 1,000 Medicare Part D beneficiaries in 2021 (Outpatient Antibiotic Use: Pharmacy Prescriptions dispensed to Medicare Part D Beneficiaries | A.R. & Patient Safety Portal). 

Penicillin Allergy De-labelling

Although approximately 10% of U.S. patients report having a penicillin class allergy, fewer than 1% of the population are found to be truly allergic to penicillins when evaluated (CDC). Identifying those not truly allergic can reduce unnecessary use of broad spectrum antibiotics. The following information may be helpful to clinicians:

• Penicillin Allergy Management - Removing Barriers to Optimal Antibiotic Prescribing
• Clinical Features of Penicillin Allergy
• A True Penicillin Allergy?