Antibiotic stewardship refers to a set of coordinated approaches to measure and improve how antibiotics are prescribed by clinicians and used by patients. Making sure antibiotics are prescribed for the right diagnosis at the right dose and for the right treatment duration is critical to effectively minimize the spread of antibiotic resistant bacteria.

• Antibiotic resistance is an expected consequence with administration of any antibiotic for any length of time. Over time antibiotic resistance has emerged to affect all antibiotics in use today, rendering them less effective (or ineffective for certain infections).
• The more antibiotics are administered, the greater the risk of emergence and spread of resistant bacteria. Unfortunately, research and development of new, novel antibiotics has slowed over the past several decades; therefore, new antibiotics will not be available to us for several years, if at all.
• The lack of availability of new antibiotics to treat evolving resistant bacteria is a serious threat to public health.
• Antibiotics are a limited resource that must be used fairly. Antibiotic stewardship can help ensure that vulnerable populations and communities have access to them, according to best practices, regardless of social determinants of health.

Everyone is responsible for antibiotic stewardship including healthcare leadership, prescribers, caregivers, and patients. Public health investment in antibiotic stewardship is important as well.

• Establish and support a culture of antibiotic stewardship within every healthcare facility or clinical practice setting
• Institute processes that take into consideration the risk of emergence of resistance with every decision to prescribe an antibiotic
• Monitor antibiotic use, and bacterial resistance

• Los Angeles County DPH Antibiotic Use Dashboard
• Basics about the NHSN Standardized Antimicrobial Administration Ratio (SAAR)

• On Demand Webinars with Free CME:
  • Penicillin Allergy Delabeling: An Antibiotic Stewardship Initiative
  • Penicillin Allergy Delabeling Part 2: A Case Based Discussion
• Toolkits, Implementation Guidance and Resources
  • Adult Low-Risk Penicillin Allergy Delabeling Toolkit for Hospitals
  • Penicillin Allergy Delabeling: Implementation Guidance and Resources
• Patient Education:
  • Penicillin Allergy Awareness Handout for Patients

Most hospitals in Los Angeles County are on the CDPH Honor Roll. View hospitals currently on the Honor Roll at: https://www.cdph.ca.gov/Programs/CHCQ/HAI/Pages/HonorRollMembers.aspx.

The California Department of Public Health (CDPH) Antibiotic Stewardship Honor Roll program recognizes institutions that have successfully implemented the CDC core elements considered vital for a successful antibiotic stewardship program (ASP). Institutions that have additionally demonstrated meaningful improved outcomes and/or engage with other community partner institutions receive additional recognition.

There are several significant benefits to the honor roll designation:

• Opportunity to receive expert evaluation of CDC ASP core element achievement without cost to your institution.
• Obtain institutional recognition for achieving a high quality of care by meeting or exceeding national guidelines.
• Receipt of a CDC honor roll certificate and logo displayable for staff and the public.
• Share your institution’s best practices to benefit others.
• Networking and collaboration opportunities across Los Angeles County and California.
• Demonstrate hospital readiness for regulatory site visit.

Los Angeles County acute care and long-term acute care hospitals: Facilities that have not applied are strongly encouraged to do so. Contact the LACDPH Antibiotic Stewardship team for questions or assistance with the application process.

• Approach to Evaluation and Monitoring of Urinary Tract Infections in Skilled Nursing Facility Residents: A Resource for Infection Preventionists and Nurses

• Antibiotic Stewardship Programs (ASP) in Skilled Nursing Facilities (2023)
• Basic Components of an Antibiotic Stewardship Program in Skilled Nursing Facilities (2023)

The Targeting Appropriate Prescribing in Outpatient Settings (TAP OUT) program was designed to assist ambulatory healthcare settings in Los Angeles County meet the CDC Core Elements of stewardship through evidence-based best practices. See our TAP OUT Playbook and slide presentations for details.

Implementation of TAP OUT at a large medical group in Los Angeles resulted in a substantial reduction in unnecessary treatment for acute bronchitis.

Resources:

• Los Angeles County DPH TAPOUT Playbook
• Outpatient Antibiotic Stewardship Training:
  • Antibiotic Stewardship in the Outpatient Setting
  • Tools to Curb Inappropriate Use of Antibiotics
  • Appropriate Treatment of Common Infections in Primary Care

• Antibiotic Stewardship Recommendations for Dentists
• Antibiotic Stewardship Implementation Guidance for Dental Offices