Antibiotic stewardship is the effort to make sure antibiotics are prescribed and used only when they clearly help. Improving antibiotic use protects patients and slows antimicrobial resistance. CDC's annual report summarizes national data on antibiotic use and the guidance and partnerships aimed at improving it across health care.
The Core Elements
In 2014 CDC published the Core Elements of Hospital Antibiotic Stewardship, setting out the structures and practices of successful stewardship programs. The framework has since been adapted for other settings, including small and critical access hospitals and dialysis, and has been used for other hospital quality programs such as sepsis and diagnostic excellence. CDC's 2016 Core Elements of Outpatient Antibiotic Stewardship are being updated in 2026 to reflect that outpatient care increasingly happens within health systems, focusing on how system leaders can build stewardship across their networks — for example, by sharing treatment recommendations for common infections through decision-support tools in electronic health records.
Priority areas
- Penicillin allergy labels. About 10% of Americans report a penicillin allergy, but fewer than 1% are truly allergic, and inaccurate labels can keep patients from the best treatment. CDC updated its clinical guidance and funded a free continuing-education course on penicillin allergy management through the Society for Healthcare Epidemiology of America.
- Pneumonia. CDC funded an American College of Chest Physicians infographic on community-acquired pneumonia, a study showing that feedback reports drawn from electronic records improved guideline adherence in a children's health system, and University of Utah electronic quality measures for inappropriately broad antibiotics and excess treatment length, endorsed with conditions in April 2025.
- Dentistry. General dentists still prescribe more than 10% of all outpatient antibiotics, and their rates did not change from 2018 to 2022 despite practice guidelines. CDC produced a summary of American Dental Association recommendations for dental pain and swelling, a prescribing checklist, and — with the Association for Dental Safety — stewardship resources and an annual summit.
Outpatient prescribing
In 2024, U.S. retail pharmacies dispensed 752 antibiotic prescriptions per 1,000 people, 1% fewer than in 2023. Rates vary by state and by prescriber specialty. Among Medicare Part D beneficiaries in 2022, family practice physicians, nurse practitioners and internal medicine clinicians wrote 52% of antibiotic prescriptions, making their professional societies important partners.
Outpatient antibiotic prescribing rates by state, 2024. CDC Antimicrobial Resistance & Patient Safety Portal
Hospitals
As of January 1, 2025, 4,362 acute care hospitals had reported antibiotic use data to the National Healthcare Safety Network's Antimicrobial Use Option, which lets hospitals compare their use with others and meets a Centers for Medicare & Medicaid Services reporting requirement. Its risk-adjusted Standardized Antimicrobial Administration Ratio was updated with 2023 data.
In 2024, 97% of hospitals met all seven Core Elements. CDC's 2022 Priorities for Hospital Core Element Implementation set a higher bar: 16% of hospitals met all six Priorities and 36% met five.
Hospitals reporting the seven Core Elements, 2013–2024. CDC Antimicrobial Resistance & Patient Safety Portal
Long-term care
In 2024, 82% of long-term care facilities met all seven Core Elements for nursing homes. CDC updated beginner and advanced guides to tracking antibiotic use in these settings and is piloting electronic reporting with facilities and health record vendors.
Long-term care facilities reporting the Core Elements, 2016–2024. CDC Antimicrobial Resistance & Patient Safety Portal
Recent findings
- Telemedicine (2021): 7% to 9% of outpatient visits with an antibiotic prescription were telemedicine visits. Antibiotics were often prescribed for respiratory conditions that do not need them, such as acute bronchitis and viral upper respiratory infections, and about 75% of sinusitis visits ended in a prescription, though most people with acute uncomplicated sinusitis recover without one.
- Hemodialysis (2012–2021): almost one in three people on hemodialysis receive an intravenous antibiotic each year, and nearly half may not need it. New IV antibiotic starts fell by nearly 7% a year from January 2012 to March 2020 and about 9% a year through December 2021. Patients with central venous catheters had much higher rates than those with grafts or fistulas.
- Antibiotics and opioids in Medicare (2021): the top 10% of antibiotic prescribers wrote 12.5 million prescriptions (36%), and the top 10% of opioid prescribers 22.3 million (52%). High-volume antibiotic prescribers often also prescribed many opioids, and such prescribers were more common in the South and in rural areas.
- COVID-19 in long-term care (2020–2023): before oral COVID-19 antivirals were authorized in December 2021, 23% of COVID-19 diagnoses came with an antibiotic order; afterward, 17% did, while 18% came with an antiviral — suggesting an effective alternative reduced unnecessary antibiotics.
Public education
CDC's Be Antibiotics Aware campaign, along with its C. diff and Get Ahead of Sepsis efforts, teaches the public and health professionals about appropriate antibiotic use. From August 2024 to January 2025, its paid online and in-office advertising earned 14.4 million impressions and 210k+ link clicks before all paid campaigns were paused on January 21, 2025. From May 2024 to June 2025, CDC's antibiotic use website drew 6 million page views and more than 154,000 downloads.
Next steps
CDC is updating stewardship guidance for common infections, including respiratory and dental infections, and working with partners — including health care payers, who can monitor prescribing quality and give clinicians feedback — to improve outpatient antibiotic use.
Sources
- Centers for Disease Control and Prevention, "Antibiotic Use and Stewardship in the United States, 2025 Update: Progress and Opportunities": https://www.cdc.gov/antibiotic-use/hcp/data-research/stewardship-report.html
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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