Better Antibiotic Stewardship May Start with Improving Diagnostic Stewardship

Urgent care as an industry has made a firm commitment to reducing inappropriate prescriptions for antibiotics. Most often, we picture a clinician resisting patient demands for a script even though they’re experiencing a viral respiratory infection or fighting the urge to write one just in case a culture comes back positive. According to a Medpage Today article based on data presented at IDWeek, a group of hospitals in Michigan found that taking a step back to consider the decision to run cultures or not may be a good way to reduce the number of antibiotics being taken inappropriately. As one expert quoted in the piece put it, asking “Are you targeting cultures to the right patients?” may preempt the decision of whether to prescribe or not. They found that “fewer tests in the wrong patients means fewer antibiotics in the wrong patients. This leads to less antibiotic harm and less resistance.” During the study period, refining the protocol for administering cultures for asymptomatic bacteriuria (ASB) led to a 6% reduction in antibiotic prescribing and lower mean duration of treatment with antibiotics overall (from 6.38 days to 5.93 days). While that paper’s focus on ASB may not resonate widely with urgent care providers, it stands to reason that the concept would hold for other prospective infections.