The effect of a multimodal stewardship approach on antibiotic prescribing for outpatients with acute respiratory tract infections: Order set implementation and education

IntroductionAlthough antimicrobial stewardship initiatives in the outpatient setting have been increasing, the effect of order set implementation on antibiotic prescribing for acute respiratory tract infections (ARTI) has not been fully established. ObjectiveThis study's objective was to determine the impact of order sets and education on antibiotic prescribing for ARTI in the outpatient setting. MethodsThis was a quasi-experimental research study conducted from January 2015 through December 2016. The study was conducted at an adult ambulatory care clinic associated with a tertiary care medical center. Order sets and prescriber education were created and implemented to aid in the diagnosis and treatment of ARTI. The primary end point was a composite of antibiotic prescribing frequency for ARTI. Secondary objectives included antibiotic appropriateness, patients requiring follow-up clinic visits, and development of Clostridioides difficile infection. ResultsA total of 3292 patients were included in the study. Unspecified respiratory tract infection (RTI) was the most common diagnosis. Antibiotic prescribing decreased from 33% to 24% in the postintervention period (relative risk 0.74 [0.64-0.85], P = <.0005). Antibiotic appropriateness was increased in the postintervention period (70%-85%, P = <.0005) and significant reductions in clinic revisits were observed in the postintervention group, from 2.3% to 0.2% (odds ratio 15.2 [3.6-64.1], P = .0002). ConclusionsImplementation of order sets and education to aid in the management of ARTI at an outpatient clinic resulted in an overall decrease in antibiotic prescribing, improvements in antibiotic appropriateness, and decreased 30-day clinic revisits. Order sets and education should be considered as a part of a multimodal approach to outpatient antimicrobial stewardship.