Antimicrobial stewardship in outpatient settings: leveraging innovative physician-pharmacist collaborations to reduce antibiotic resistance

Antibiotic resistance is one of the world's most pressing public health problems. Historically, most drug-resistant bacteria have emerged in hospital settings, yet the vast majority of antimicrobials used in humans in the United States are administered in outpatient settings. Strong collaboration between physicians and pharmacists in the development of antimicrobial stewardship programs in outpatient settings is thus a critical strategy for curtailing antibiotic resistance. Recently, pilot projects have been launched in 3 states that pair physicians and community pharmacists under a Collaborative Practice Agreement (CPA) to treat patients with influenza and group A Streptococcus (GAS) pharyngitis. Under this model, community pharmacists use rapid point-of-care tests to guide clinical decision making and initiate treatment as appropriate under a physician-led, evidence-based protocol. Experience with this research initiative has suggested this model can lead to more judicious use of antibiotics and antivirals, improve public health, and provide safe and convenient care for patients.