Antibiotic resistance is a growing national threat to public health safety. Nearly 50% of antibiotic prescriptions are not necessary or appropriate in the outpatient setting. We conducted a multimodal assessment to guide antibiotics stewardship program activities and interventions.

A patient and a provider survey was created to assess knowledge, attitude, and behavior toward antibiotics. In addition, a verbal education and distribution of a flowchart to providers in two clinics describing the 2010-IDSA/ESCMID guidelines for treatment of uncomplicated cystitis was provided. Charts were reviewed to assess antibiotics use pre- and post-intervention for a 6-month period.

Patient Survey: 85 patients completed the patient questionnaire. 38% recognize the relationship between over usage of antibiotics and the emergence of antibiotic-resistant organisms. Moreover, 17% of participants felt that they were wasting their time if they go to a doctor with an infection and they were not prescribed an antibiotic. Noteworthy, 86% of the patients surveyed wanted to learn more about antibiotics. Provider Surveys: Providers chose guideline-appropriate treatment for acute uncomplicated cystitis 56% of the time, and for uncomplicated pyelonephritis 44% of the time. Over 75% of the non-guideline appropriate treatments were due to an incorrect duration, with a majority (>85%) prescribing antibiotic longer than required. Intervention: During the pre-intervention 24 patients (65%) received an antibiotic with a guideline concordant dose, duration, and frequency. Post intervention 12 patients (32%) received a longer duration than recommended. Post-intervention, 55% received an overall guideline-concordant antibiotic demonstrating there was no significant change in prescribers’ practices after the intervention. Post intervention 12 patients (39%) received a longer duration than recommended.

There is an unmet need to address patient and provider knowledge deficits and behaviors towards antibiotics. Future projects will need to include a more active approach to antibiotic stewardship in order to engage both patients and providers.