The Infectious Diseases Society of America (IDSA) defines antimicrobial stewardship as the "coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration."¹ These efforts seek to improve clinical outcomes, reduce health care costs, and slow bacterial resistance rates.

The following tips can help to promote antimicrobial stewardship:

• Consider practicing "watchful waiting" for upper respiratory infections in children and acute bronchitis in adults. Examples include:
  • – The 3-Day Rule: Follow up with patients three days after the initial visit to discuss treatment options if symptom relief has not occurred.
  • – The Poster Board Pledge: Display a poster-sized commitment letter in exam rooms to avoid inappropriate antibiotic prescribing. Recent studies show this as a simple, low-cost, and effective method for improvement.²
• Order group A streptococcus tests in children with pharyngitis prior to ordering antibiotics as "only about 30 percent of all cases of pharyngitis in children are caused by bacteria. Be sure to follow the pediatric guidelines for appropriate treatment."³
• Minimize the use of broad-spectrum antibiotics when narrow-spectrum antibiotics are indicated and recommended.

¹http://www.idsociety.org/Stewardship_Policy/ and http://www.who.int/mediacentre/factsheets/antibiotic-resistance/ en/

²Meeker D, et al. ?Nudging guideline-concordant antibiotic prescribing: A randomized clinical trial,? JAMA Intern Med. 2014;174(3):425-31.

³National Committee for Quality Assurance (NCQA). The State of Health Care Quality 2014. Washington (DC): National Committee for Quality Assurance (NCQA); Final Edition 2014; p. 70.