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

• Published in: Journal of the American Geriatrics Society (JAGS) 2020-02, Vol.68 (2), p.244-249
• Main Authors: Pulia, Michael S., Keller, Sara C., Crnich, Christopher J., Jump, Robin L.P., Yoshikawa, Thomas T.
• Format: Article
• Language: English
• Subjects: adverse drug reactions; Aged; Ambulatory care; Ambulatory Care - methods; Ambulatory Care - organization & administration; Ambulatory Care Facilities - organization & administration; Anti-Bacterial Agents - administration & dosage; Anti-Bacterial Agents - adverse effects; antibiotic stewardship; Antibiotics; Antimicrobial Stewardship - methods; Antimicrobial Stewardship - organization & administration; Aorta; Aortic dissection; emergency department; Humans; Inappropriate Prescribing - prevention & control; infection; Older people; Practice Patterns, Physicians; Respiratory Tract Infections - drug therapy
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.16256

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