Guidelines
Outpatient Trends in 2020

Outpatient Trends in 2020

Outpatient Trends in 2020

  • Rates of VRE (4%) and MRSA (23%) stable from last year
  • No major changes in susceptibility patterns from previous years
  • Only 2 isolates of S. pneumoniae so unable to analyze azithromycin/doxycycline resistance
    • Continue using two-drug regimen for community-acquired pneumonia for patients with comorbidities

Note: Outpatient antibiograms do not reflect patients who are sick enough to warrant possible hospitalization

Recommendations

  • Antibiotics should only be used in those at high risk of bacterial infection to prevent resistance and adverse events
  • Avoid overuse in acute exacerbation of chronic bronchitis or stable, mild diverticulitis
  • Consider the shortest duration and most narrow antimicrobial therapy possible to minimize collateral damage (e.g. C. difficile)

Avoid fluoroquinolones in acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis and uncomplicated cystitis due to increased risk of serious adverse events with this drug class including: 

  • Tendinitis
  • Joint pain
  • Depression
  • Altered mental status
  • Peripheral neuropathy
  • Increased risk of ruptures or tears in the aorta
  • Over 90% of patients who report a penicillin allergy are not truly allergic, and 80% of patients lose allergenicity over 10 years
  • A careful allergy history may help determine if alternate beta-lactam antibiotics can be used
  • Consider referral to allergy clinic for further assessment

More Information

Johns Hopkins Abx Guide, Sanford Guide of Antimicrobial Therapy, IDSA Guidelines: for included infections available at: www.idsociety.org