Antibiotic stewardship moved up from the clinic to the health system

Outpatient settings — clinics, urgent care, a GP's office — are where most
antibiotics are prescribed, which makes them an important part of antibiotic
stewardship. **Stewardship programmes promote appropriate antibiotic use to
improve patient care and to combat antimicrobial resistance.**

In **2026 the CDC updated its 2016 Core Elements of Outpatient Antibiotic
Stewardship**, based on published evidence and on real-world implementation
experience since.

What changed

**The updated guidance places greater emphasis on the role health systems can
play in improving antibiotic prescribing across their network**, while
continuing to cover stewardship at the independent clinic and individual
clinician level.

That shift is the substance of the update. The 2016 framework largely
addressed the prescriber; ten years of implementation suggested that a health
system — which controls the electronic record, the default order sets, the
audit and the feedback loop — can change prescribing in ways an individual
clinician cannot.

What the guidance contains

The framework outlines the structural and procedural components of an
effective outpatient stewardship programme, with adaptable strategies for
different settings. Alongside it:

• An assessment tool for evaluating stewardship efforts
• A resource for measuring antibiotic use (Appendix A: Measurement and
  Evaluation of Antibiotic Use)
• Fact sheets tailoring stewardship strategies to specific outpatient
  settings

Measurement is the piece that makes the rest work: a programme that cannot
measure its own prescribing has no way to tell whether it has changed
anything.

**Effective antibiotic stewardship programmes protect patients and improve
clinical outcomes** — the benefit is not only the collective one of slowing
resistance, but a better outcome for the individual patient who does not
receive an antibiotic they did not need.

Source: Centers for Disease Control and Prevention.