Outpatient antibiotic stewardship during the COVID-19 era: analysis of prescribing trends and guideline compliance.

Objective: To analyze antibiotic prescribing trends and guideline concordance in outpatient settings using electronic health records (EHRs). Design: This quality improvement study utilized data from the Collaboration to Harmonize Antimicrobial Registry Measures (CHARM) database, which integrates antibiotic prescribing data extracted from the EHRs of various outpatient facilities. Setting: The study was conducted across 352 outpatient facilities in the United States. Participants: The study included oral antibiotic prescribing data from outpatient encounters from January 2021 to June 2023, encompassing 823,938 prescriptions. Methods: The primary outcomes were the rate of antibiotic prescribing per 1 000 prescription-related outpatient visits and identifying frequently prescribed antibiotics in adults and children. Secondary outcomes were the prescribing patterns for selected diagnoses and the concordance of these prescriptions with published guidelines. Results: The study estimated approximately a 20% increase in antibiotic prescribing per year, with an overall rate of 121.26 prescriptions per 1 000 prescription-related outpatient visits (95% confidence interval 121.01-121.50). Amoxicillin-clavulanate, amoxicillin, doxycycline, and cephalexin were most frequently prescribed. Sinusitis and otitis media were the most common reasons for prescribing antibiotics among adults and children, respectively. Less than 60% of sinusitis-related prescriptions were antibiotic concordant. Duration concordance rates were less than 70% for sinusitis, urinary tract infections, cellulitis, and Group A Streptococci. 51% of ciprofloxacin prescriptions were for patients aged 60 or older. Conclusions: The findings stress the need for strengthened antimicrobial stewardship in outpatient settings. The increasing rate of antibiotic prescriptions and discrepancies in guideline concordance reiterate the importance of ongoing monitoring and targeted interventions.