What do clinical guidelines say about antibiotic stewardship in primary care?

<keypoints> - Australia's antibiotic use is among the highest in the developed world, with approximately half of outpatient prescriptions potentially inappropriate - The **CDC Core Elements of Outpatient Antibiotic Stewardship** framework identifies four pillars: Commitment, Action, Tracking & Reporting, and Education & Expertise - A scoping review identified **six key components** for AMS in general practice: governance, education, consultation support (including prescribing guidelines and point-of-care tests), pharmacist/nurse involvement, monitoring with feedback, and research translation - **Delayed prescribing** and **watchful waiting** are evidence-based strategies that safely decrease antibiotic use when applied per clinical practice guidelines - In Australia, **Therapeutic Guidelines: Antibiotic (eTG)** is the nationally accepted prescribing guideline resource for primary care, and PBS restrictions (e.g. on macrolides) function as a structural stewardship measure </keypoints>

The Four Core Elements (CDC Framework)

The CDC's 2016 Core Elements of Outpatient Antibiotic Stewardship remains the most widely referenced framework for primary care stewardship and is applicable across outpatient settings:

1. Commitment: demonstrate leadership dedication to optimising prescribing and patient safety
2. Action: implement at least one policy or practice to improve prescribing, assess its effectiveness, and modify as needed
3. Tracking and reporting: monitor prescribing practices and provide regular feedback to clinicians
4. Education and expertise: provide educational resources to clinicians and patients, and ensure access to expertise on optimising prescribing

An updated version of the Outpatient Core Elements is expected in 2026, with emphasis on the role of health system leadership in supporting stewardship program development.

Practical Strategies for General Practice

Prescribing Interventions