Antimicrobial Stewardships Reduce Unnecessary Antibiotic Exposure for Respiratory Infections

Multifaceted antimicrobial stewardship initiatives can reduce unnecessary antibiotic exposure and improve adherence to medication duration for patients with respiratory tract infections, according to results of a study published in Antimicrobial Stewardship and Healthcare Epidemiology.

Various stewardship programs have been implemented internationally to reduce unnecessary antibiotic exposure and improve patient’s outcomes,” the study authors said.¹ “In our study, we used a multifaceted intervention to guide the physicians to choose the shortest effective duration, which led to a 38.2% reduction in the DOT per 1 000 visits and a[n] 11.7% improvement in adherence to evidence-based duration.”

Antimicrobial resistance is a significant public health threat, according to authors from a review in Cureus. Over 2 million people in the US encounter infections resistant to frontline treatment, and it is projected that by 2025, 10 million people will die globally each year. Pharmacists involved in antimicrobial stewardship can help to facilitate the appropriate use of antibiotics and are not limited to any clinical setting. Antimicrobial stewardship includes education, informatics drug information, coaching, and evaluating patients. Pharmacists are required to be familiar with core infectious diseases for successful implementation.^2,3

In the current study, investigators conducted a quasi-experimental study in Riyadh, Saudi Arabia. They compared oral antibiotics prescribed for respiratory tract infections in the preintervention phase from June to December 2021 and the postintervention phase from January to June 2022. During the study period, investigators reported that 2335 patients received oral antibiotics for respiratory infections in the outpatient setting. There were 15 patients excluded, so 2320 patients were in the final study, with 1359 in the preintervention period and 961 in the postintervention period.¹

Approximately 91.5% had upper respiratory tract infections, and β-lactams were the most frequently prescribed agent at 65.8%, followed by macrolides at 32.8%, fluoroquinolones at 1.1%, and doxycycline at 0.3%. Following the implementation of the multifaceted stewardship initiative, investigators noted improvements in antibiotic prescribing. The day of therapy per 1000 outpatient visits decreased from 131 to 50, and the mean duration of antibiotic therapy declined from 6.3 to 6 days, according to the results. Adherence to the duration of medication improved from 54.2% to 58.8%.¹

“Although the mean duration of therapy decreased significantly from 6.4 to 6.0 days, this reduction is unlikely to be clinically meaningful in practice,” the study authors said.¹ “However, this finding suggests that outpatient antibiotic prescribing practices may not [be] alarming.”

Furthermore, investigators reported the intervention increased the odds of adherence to recommended antibiotic durations, with adults having higher odds than pediatric patients. Furthermore, patients who visited outpatient clinics also had higher adherence odds compared with those who visited the emergency department.¹

“In our study, the shift in antibiotic use from β-lactams to other agents in the postintervention period may reflect evolving prescribing behaviors within the emergency medicine service or emerging resistance patterns, particularly during the COVID-19 pandemic,” the study investigators concluded.¹

READ MORE: Respiratory Resource Center

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REFERENCES

1. Alghamdi A, Alraey M, Khan MA, et al. Impact of multifaceted clinical decision support and education on antibiotic duration in outpatients with respiratory tract infections in Saudi Arabia: a prospective pre- and postimplementation study. Antimicrob Steward Healthc Epidemiol. 2025;5(1):e304. Published 2025 Nov 17. doi:10.1017/ash.2025.10219

2. Dighriri IM, Alnomci BA, Aljahdali MM, et al. The Role of Clinical Pharmacists in Antimicrobial Stewardship Programs (ASPs): A Systematic Review. Cureus. 2023;15(12):e50151. Published 2023 Dec 8. doi:10.7759/cureus.50151

3. ID Stewardship. What is an antimicrobial stewardship pharmacist?. Accessed December 2, 2025. https://www.idstewardship.com/id-pharmd-qa/antimicrobial-stewardship-pharmacist/