Antibiotic Stewardship for Older Adults in Ambulatory Care Settings: Addressing an Unmet Challenge

Michael S Pulia 1, Sara C Keller 2, Christopher J Crnich 3 4, Robin L P Jump 5 6 7 8, Thomas T Yoshikawa 9 10 11

Affiliations

PMID: 31750937
PMCID: PMC7228477 (available on 2021-02-01)
DOI: 10.1111/jgs.16256

Free PMC article

Abstract

Inappropriate antibiotic use is common in older adults (aged >65 y), and they are particularly vulnerable to serious antibiotic-associated adverse effects such as cardiac arrhythmias, delirium, aortic dissection, drug-drug interactions, and Clostridioides difficile. Antibiotic prescribing improvement efforts in older adults have been primarily focused on inpatient and long-term care settings. However, the ambulatory care setting is where the vast majority of antibiotic prescribing to older adults occurs. To help improve the clinical care of older adults, we review drivers of antibiotic prescribing in this population, explore systems aspects of ambulatory care that can create barriers to optimal antibiotic use, discuss existing stewardship interventions, and provide guidance on priority areas for future inquiry. J Am Geriatr Soc 68:244-249, 2020.

Keywords: adverse drug reactions; ambulatory care; antibiotic stewardship; emergency department; infection.

Conflict of interest statement

Conflict of Interest:

MP has served as Co-Investigator on a research study funded by Roche. RJ is the Principal Investigator on research grants from Pfizer and Accelerate; she has also participated in advisory boards for Pfizer and Merck. None of the other authors have relevant conflicts of interest to disclose.