Evaluation of a Large Urban–Rural Outpatient Antibiotic Stewardship Program

Background: Judicious prescribing of antibiotics is necessary in addressing the crisis of emerging antibiotic resistance and reducing adverse events. Nearly half of antibiotic prescriptions in the outpatient setting are inappropriate, most for viral upper respiratory infections (URIs). Data outlining the misuse of antibiotics in the outpatient setting provide compelling evidence of the need for more rational use of antimicrobial agents beyond hospital settings. Objectives: We evaluated the effect of a behaviorally enhanced quality improvement (QI) intervention to reduce inappropriate antibiotic prescribing for viral URI in the ambulatory care clinics of a large quaternary care healthcare system serving an urban-rural population. Methods: The outpatient antibiotic stewardship program was implemented in January 2018 at 5 pilot sites. Interventions included identification of a site champion, educational sessions, sharing of clinic and individual provider data, and patient and provider educational materials. In addition, preclinic huddles and resident education sessions for internal medicine resident physicians were conducted with a display of public commitment to prescribe antibiotics appropriately. Site champions collaborated with onsite staff to ensure interventions were consistent with local workflows, policies, and standards. The primary outcome was defined as the provider-level antibiotic prescribing rate for acute URI, defined as patient visits with antibiotic-nonresponsive diagnoses without concomitant diagnostic codes to support antibiotic prescribing (see the public MITIGATE tool kit for a complete list). Results: In total, 116,122 antibiotic prescriptions were dispensed from April 2017 through December 2018 compared to the period from April 2017 to December 2017 during which 9,129 fewer prescriptions were ordered. Inappropriate antibiotic prescribing for viral URI for ambulatory clinic encounters (n ≥ 45,000 visits per month) declined from 14.3% to 7.6%. Academic hospital-based sites showed little seasonality trends and no statistically significant decrease in prescription rates (P = .5176). On the other hand, community-based sites showed strong seasonal fluctuations and a statistically significant decrease in prescription rates after intervention (P = .000189). Conclusions: A multifaceted behaviorally enhanced QI intervention to reduce inappropriate prescribing for URI in ambulatory care encounters at a large integrated health system was successful in reducing both inappropriate prescriptions for presumed viral URI as well as total antibiotic use. Findings suggest that implementing leadership roles, education sessions, and low resource behavioral nudging (peer comparison and public commitment) together can decrease excessive use of antibiotics by physicians. A Hawthorne effect may be an important component of these interventions. Future studies are needed in order to determine the optimal combination of behavioral interventions that are cost-effective in outpatient settings.Funding: NoneDisclosures: Larissa May reports receiving speaking honoraria from Cepheid, research grants from Roche, and consultancy fees from BioRad and Nabriva. She serves on the advisory board for Qvella.

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142. Implementing an Antimicrobial Stewardship Program in the Outpatient Setting

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.187 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S82-S82

Author(s):

Travis B Nielsen ◽

Maressa Santarossa ◽

Beatrice D Probst ◽

Laurie Labuszewski ◽

Jenna Lopez ◽

...

Keyword(s):

Primary Care ◽

Antimicrobial Stewardship ◽

Inappropriate Prescribing ◽

The United States ◽

Outpatient Setting ◽

Urgent Care ◽

Antibiotic Prescribing ◽

Antimicrobial Stewardship Program ◽

Post Intervention ◽

Stewardship Program

Abstract Background Antimicrobial-resistant infections lead to increased morbidity, mortality, and healthcare costs. Among the most facile modifiable risk factors for developing resistance is inappropriate prescribing. The CDC estimates that 47 million (or ≥30% of) outpatient antibiotic prescriptions in the United States are unnecessary. This has provided impetus for expanding our antimicrobial stewardship program (ASP) into the outpatient setting. Initial goals included the following: continuous evaluation and reporting of antibiotic prescribing compliance; minimize underuse of antibiotics from delayed diagnoses and misdiagnoses; ensure proper drug, dose, and duration; improve the percentage of appropriate prescriptions. Methods To achieve these goals, we first sent a baseline survey to outpatient prescribers, assessing their understanding of stewardship and antimicrobial resistance. Questions were modeled from the Illinois Department of Public Health (IDPH) Precious Drugs & Scary Bugs Campaign. The survey was sent to prescribers at 19 primary care and three immediate/urgent care clinics. Compliance rates for prescribing habits were subsequently tracked via electronic health records and reported to prescribers in accordance with IRB approval. Results Prescribers were highly knowledgeable about what constitutes appropriate prescribing, with verified compliance rates highly concordant with self-reported rates. However, 74% of respondents reported intense pressure from patients to inappropriately prescribe antimicrobials. Compliance rates have been tracked since December 2018 and comparing pre- with post-intervention rates shows improvement in primary care since reporting rates to prescribers in August 2019. Conclusion Reporting compliance rates has been helpful in avoiding inappropriate antimicrobial therapy. However, the survey data reinforce the importance of behavioral interventions to bolster ASP efficacy in the outpatient setting. Going forward, posters modeled off of the IDPH template will be conspicuously exhibited in exam rooms, indicating institutional commitment to the enumerated ASP guidelines. Future studies will allow for comparison of pre- and post-intervention knowledge and prescriber compliance. Disclosures All Authors: No reported disclosures

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The Prescribing Trends of Metronidazole in The Outpatient Setting

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2020/v32i430421 ◽

2020 ◽

pp. 24-29 ◽

Cited By ~ 1

Author(s):

Nehad J. Ahmed

Keyword(s):

Public Hospital ◽

Bacterial Resistance ◽

Inappropriate Prescribing ◽

Outpatient Setting ◽

Prescribing Patterns ◽

Antibiotic Prescribing ◽

Descriptive Data ◽

Prescribing Pattern ◽

Stewardship Program ◽

Prescribing Trends

Aim: The aim of this study is to characterize the trends of metronidazole prescribing in outpatient setting in Alkharj. Methodology: This is a retrospective study includes evaluating outpatient antibiotic prescriptions from 01-01-2018 till 31-12-2018 in a public hospital Alkharj. The data were collected and analyzed using excel software and the descriptive data were represented by frequencies and percentages. Results: The majority of the metronidazole prescriptions were regular and only few prescriptions were urgent. The physicians who prescribed metronidazole were mainly residents who don’t have sufficient experience that may results in more inappropriate antibiotic prescribing patterns. Conclusion: The excessive use of metronidazole in addition to its prescribing by resident may results in inappropriate prescribing pattern that may lead to increase the adverse effect which may lead to increase the rate of bacterial resistance. More efforts are needed, especially by applying antimicrobial stewardship program, to ensure that metronidazole is prescribed correctly.

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Successful Implementation of an Antibiotic Stewardship Program in an Academic Dental Practice

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz067 ◽

2019 ◽

Vol 6 (3) ◽

Cited By ~ 17

Author(s):

Alan E Gross ◽

Danny Hanna ◽

Susan A Rowan ◽

Susan C Bleasdale ◽

Katie J Suda

Keyword(s):

Antibiotic Stewardship ◽

Guideline Development ◽

The United States ◽

Outpatient Setting ◽

Urgent Care ◽

Antibiotic Prescribing ◽

Successful Implementation ◽

Provider Education ◽

Multimodal Intervention ◽

Stewardship Program

AbstractBackgroundMost antibiotic use in the United States occurs in the outpatient setting, and 10% of these prescriptions are generated by dentists. The development of comprehensive antibiotic stewardship programs (ASPs) in the dental setting is nascent, and therefore we describe the implementation of a dental ASP.MethodsA collaborative team of dentist, pharmacist, and physician leaders conducted a baseline needs assessment and literature evaluation to identify opportunities to improve antibiotic prescribing by dentists within Illinois’ largest oral health care provider for Medicaid recipients. A multimodal intervention was implemented that included patient and provider education, clinical guideline development, and an assessment of the antibiotic prescribing rate per urgent care visit before and after the educational interventions.ResultsWe identified multiple needs, including standardization of antibiotic prescribing practices for patients with acute oral infections in the urgent care clinics. A 72.9% decrease in antibiotic prescribing was observed in urgent care visits after implementation of our multimodal intervention (preintervention urgent care prescribing rate, 8.5% [24/283]; postintervention, 2.3% [8/352]; P < .001).ConclusionsWe report the successful implementation of a dental ASP that is concordant with the Centers for Disease Control and Prevention Core Elements of Antibiotic Stewardship in the Outpatient Setting. Our approach may be adapted to other dental practices to improve antibiotic prescribing.

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Antimicrobial Stewardship Interventions to Optimize Treatment of Infections in Nursing Home Residents: A Systematic Review and Meta-Analysis

Journal of Applied Gerontology ◽

10.1177/07334648211018299 ◽

2021 ◽

pp. 073346482110182

Author(s):

Sainfer Aliyu ◽

Jasmine L. Travers ◽

S. Layla Heimlich ◽

Joanne Ifill ◽

Arlene Smaldone

Keyword(s):

Systematic Review ◽

Nursing Home ◽

Antibiotic Stewardship ◽

Meta Analysis ◽

Nursing Home Residents ◽

Antibiotic Use ◽

Antibiotic Prescribing ◽

Prescribing Practices ◽

Stewardship Program ◽

Meta Analyses

Effects of antibiotic stewardship program (ASP) interventions to optimize antibiotic use for infections in nursing home (NH) residents remain unclear. The aim of this systematic review and meta-analysis was to assess ASPs in NHs and their effects on antibiotic use, multi-drug-resistant organisms, antibiotic prescribing practices, and resident mortality. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review and meta-analysis using five databases (1988–2020). Nineteen articles were included, 10 met the criteria for quantitative synthesis. Inappropriate antibiotic use decreased following ASP intervention in eight studies with a pooled decrease of 13.8% (95% confidence interval [CI]: [4.7, 23.0]; Cochran’s Q = 166,837.8, p < .001, I2 = 99.9%) across studies. Decrease in inappropriate antibiotic use was highest in studies that examined antibiotic use for urinary tract infection (UTI). Education and antibiotic stewardship algorithms for UTI were the most effective interventions. Evidence surrounding ASPs in NH is weak, with recommendations suited for UTIs.

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An antibiotic stewardship programme to reduce inappropriate antibiotic prescribing for acute respiratory infections in rural Chinese primary care facilities: study protocol for a clustered randomised controlled trial

10.21203/rs.3.rs-18556/v1 ◽

2020 ◽

Author(s):

Chao Zhuo ◽

Xiaolin Wei ◽

Zhitong Zhang ◽

Joseph Paul Hicks ◽

Jinkun Zheng ◽

...

Keyword(s):

Primary Care ◽

Antibiotic Stewardship ◽

Respiratory Infections ◽

Inappropriate Prescribing ◽

Antibiotic Prescribing ◽

Acute Respiratory Infections ◽

Care Facilities ◽

Randomised Controlled ◽

Antibiotic Stewardship Programme

Abstract Background: Inappropriate prescribing of antibiotics for acute respiratory infections at primary care level represents the major source of antibiotic misuse in healthcare, and is a major driver for antimicrobial resistance worldwide. In this study we will develop, pilot and evaluate the effectiveness of a comprehensive antibiotic stewardship programme in China’s primary care hospitals to reduce inappropriate prescribing of antibiotics for acute respiratory infections among all ages.Methods: We will use a parallel-group, cluster-randomised, controlled, superiority trial with blinded outcome evaluation but unblinded treatment (providers and patients). We will randomise 34 primary care hospitals from two counties within Guangdong province into the intervention and control arm (1:1 overall ratio) stratified by county (8:9 within-county ratio). In the control arm, antibiotic prescribing and management will continue through usual care. In the intervention arm, we will implement an antibiotic stewardship programme targeting family physicians and patients/caregivers. The family physician components include: 1) training using new operational guidelines, 2) improved management and peer-review of antibiotic prescribing, 3) improved electronic medical records and smart phone app facilitation. The patient/caregiver component involves patient education via family physicians, leaflets and videos. The primary outcome is the proportion of prescriptions for acute respiratory infections (excluding pneumonia) that contain any antibiotic(s). Secondary outcomes will address how frequently specific classes of antibiotics are prescribed, how frequently key non-antibiotic alternatives are prescribed and the costs of consultations. We will conduct a qualitative process evaluation to explore operational questions regarding acceptability, cultural appropriateness and burden of technology use, as well as a cost-effectiveness analysis and a long-term benefit evaluation. The duration of the intervention will be 12 months, with another 24 months post-trial long-term follow-up.Discussion: Our study is one of the first trials to evaluate the effect of an antibiotic stewardship programme in primary care settings in a low- or middle-income country (LMIC). All intervention activities will be designed to be embedded into routine primary care with strong local ownership. Through the trial we intend to impact on clinical practice and national policy in antibiotic prescription for primary care facilities in rural China and other LMICs.Trial registration: ISRCTN, ISRCTN96892547. Registered 18 August 2019, http://www.isrctn.com/ISRCTN96892547

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Patient Knowledge and Experiences With Antibiotic Use and Delayed Antibiotic Prescribing in the Outpatient Setting

Journal of Pharmacy Practice ◽

10.1177/0897190019889427 ◽

2019 ◽

pp. 089719001988942 ◽

Cited By ~ 2

Author(s):

Mary Beth A. Seipel ◽

Emily S. Prohaska ◽

Janelle F. Ruisinger ◽

Brittany L. Melton

Keyword(s):

Antibiotic Stewardship ◽

General Public ◽

Community Pharmacists ◽

Antibiotic Use ◽

Outpatient Setting ◽

Antibiotic Prescribing ◽

Patient Knowledge ◽

Cross Sectional Survey ◽

Chi Square ◽

Cross Sectional

Background: Most antibiotic prescriptions originate in the outpatient setting and an estimated 30% are unnecessary. Pharmacists are well positioned to positively impact antibiotic prescribing habits; the role of the community pharmacist in outpatient antibiotic stewardship programs is not well defined. Objectives: The objectives of this study were to (1) assess the knowledge of the general public regarding appropriate antibiotic use, and (2) assess the experiences of the general public regarding delayed antibiotic prescriptions. Methods: A cross-sectional survey was administered at community pharmacies in Kansas from September 2018 to January 2019. Eligible individuals were older than 18 years and self-reported their ability to speak and read English. The 22-item survey collected demographics, knowledge regarding appropriate antibiotic use, and participant understanding and experiences of delayed antibiotic prescribing. Descriptive statistics assessed demographics and chi-square compared responses between demographics. Results: Of 347 surveys completed, respondents were mainly Caucasian (91.6%), female (58.2%), and aged 60 years or older (59.1%). Those with high school education or below were more likely to believe antibiotics kill viruses (43.1% vs 20.9%, respectively; p < 0.01) and that antibiotics work on most coughs and colds (31.4% vs 16.2%, respectively; p = 0.01). Delayed antibiotic prescriptions were more frequently offered to those who had received an antibiotic prescription in the last year compared to those who had not (36.1% vs 15%, p < 0.001). Conclusion: Gaps in patient knowledge about appropriate antibiotic use and delayed prescribing present an opportunity for community pharmacists to educate patients and become involved in outpatient antibiotic stewardship.

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An antibiotic stewardship program in a surgical ICU of a resource-limited country: financial impact with improved clinical outcomes

Journal of Pharmaceutical Policy and Practice ◽

10.1186/s40545-020-00272-w ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Kashif Hussain ◽

Muhammad Faisal Khan ◽

Gul Ambreen ◽

Syed Shamim Raza ◽

Seema Irfan ◽

...

Keyword(s):

Antibiotic Stewardship ◽

Inappropriate Prescribing ◽

Cost Effective ◽

University Hospital ◽

Audit And Feedback ◽

Source Control ◽

Defined Daily Dose ◽

Contributing Factors ◽

Surgical Intensive Care ◽

Stewardship Program

Abstract Background Antibiotic resistance (ABX-R) is alarming in lower/middle-income countries (LMICs). Nonadherence to antibiotic guidelines and inappropriate prescribing are significant contributing factors to ABX-R. This study determined the clinical and economic impacts of antibiotic stewardship program (ASP) in surgical intensive care units (SICU) of LMIC. Method We conducted this pre and post-test analysis in adult SICU of Aga Khan University Hospital, Pakistan, and compared pre-ASP (September–December 2017) and post-ASP data (April–July 2018). January–March 2018 as an implementation/training phase, for designing standard operating procedures and training the team. We enrolled all the patients admitted to adult SICU and prescribed any antibiotic. ASP-team daily reviewed antibiotics prescription for its appropriateness. Through prospective-audit and feedback-mechanism changes were made and recorded. Outcome measures included antibiotic defined daily dose (DDDs)/1000 patient-days, prescription appropriateness, antibiotic duration, readmission, mortality, and cost-effectiveness. Result 123 and 125 patients were enrolled in pre-ASP and post-ASP periods. DDDs/1000 patient-days of all the antibiotics reduced in the post-ASP period, ceftriaxone, cefazolin, metronidazole, piperacillin/tazobactam, and vancomycin showed statistically significant (p < 0.01) reduction. The duration of all antibiotics use reduced significantly (p < 0.01). Length of SICU stays, mortality, and readmission reduced in the post-ASP period. ID-pharmacist interventions and source-control-documentation were observed in 62% and 50% cases respectively. Guidelines adherence improved significantly (p < 0.01). Net cost saving is 6360US$ yearly, mainly through reduced antibiotics consumption, around US$ 18,000 (PKR 2.8 million) yearly. Conclusion ASP implementation with supplemental efforts can improve the appropriateness of antibiotic prescriptions and the optimum duration of use. The approach is cost-effective mainly due to the reduced cost of antibiotics with rational use. Better source-control-documentation may further minimize the ABX-R in SICU.

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Outcomes of an ambulatory care pharmacist-led antimicrobial stewardship program within a family medicine resident clinic

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1275 ◽

2020 ◽

pp. 1-7

Author(s):

Lindsey R. Westerhof ◽

Lisa E. Dumkow ◽

Tarajo L. Hanrahan ◽

Samantha V. McPharlin ◽

Nnaemeka E. Egwuatu

Keyword(s):

Family Medicine ◽

Ambulatory Care ◽

Antimicrobial Stewardship ◽

Antibiotic Prescribing ◽

Antimicrobial Stewardship Program ◽

Upper Respiratory Tract ◽

Family Medicine Residency ◽

Medicine Resident ◽

Stewardship Program ◽

Tract Infections

Abstract Objective: To determine whether an ambulatory care pharmacist (AMCP)-led intervention improved outpatient antibiotic prescribing in a family medicine residency clinic (FMRC) for upper respiratory tract infections (URIs), urinary tract infections (UTIs), and skin and soft-tissue infections (SSTIs). Design: Retrospective, quasi-experimental study comparing guideline-concordant antibiotic prescribing before and after an antimicrobial stewardship program (ASP) intervention. Setting: Family medicine residency clinic affiliated with a community teaching hospital. Participants: Adult and pediatric patients prescribed antibiotics for URI, UTI, or SSTI between November 1, 2017, and April 31, 2018 (pre-ASP group), or October 1, 2018, and March 31, 2019 (ASP group), were eligible for inclusion. Methods: The health-system ASP physician and pharmacist provided live education and pocket cards to FMRC staff with local guidelines as a quick reference. Audit with feedback was delivered every other week by the clinic’s AMCP. Guideline-concordance was determined based on the institution’s outpatient ASP guidelines. Results: Overall, 525 antibiotic prescriptions were audited (pre-ASP n = 90 and ASP n = 435). Total guideline-concordant antibiotic prescribing at baseline was 38.9% (URI, 53.3%; SSTI, 16.7%; UTI, 46.7%) and improved across all 3 infection types to 57.9% (URI, 61.2%; SSTI, 57.6%; UTI, 53.5%; P = .001). Significant improvements were seen in guideline-concordant antibiotic selection (68.9% vs 80.2%; P = .018), dose (76.7% vs 86.2%; P = .023), and duration of therapy (73.3% vs 86.2%; P = .02). Conclusions: An AMCP-led outpatient ASP intervention significantly improved guideline-concordant antibiotic prescribing for common infections within a FMRC.

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The Effect of Expert Feedback on Antibiotic Prescribing in Pediatrics: Experimental Evidence

Medical Decision Making ◽

10.1177/0272989x19866699 ◽

2019 ◽

Vol 39 (7) ◽

pp. 781-795 ◽

Cited By ~ 2

Author(s):

Kerstin Eilermann ◽

Katrin Halstenberg ◽

Ludwig Kuntz ◽

Kyriakos Martakis ◽

Bernhard Roth ◽

...

Keyword(s):

Clinical Experience ◽

Antibiotic Stewardship ◽

Causal Effect ◽

Effective Means ◽

Inappropriate Prescribing ◽

Intervention Group ◽

Individual Characteristics ◽

Pediatric Care ◽

Antibiotic Prescribing ◽

Development Of Resistance

Background. Inappropriate prescribing of antibiotics, which is common in pediatric care, is a key driver of antimicrobial resistance. To mitigate the development of resistance, antibiotic stewardship programs often suggest the inclusion of feedback targeted at individual providers. Empirically, however, it is not well understood how feedback affects individual physicians’ antibiotic prescribing decisions. Also, the question of how physicians’ characteristics, such as clinical experience, relate to antibiotic prescribing decisions and to responses to feedback is largely unexplored. Objective. To analyze the causal effect of descriptive expert feedback (and individual characteristics) on physicians’ antibiotic prescribing decisions in pediatrics. Design. We employed a randomized, controlled framed field experiment, in which German pediatricians ( n=73) decided on the length of first-line antibiotic treatment for routine pediatric cases. In the intervention group ( n=39), pediatricians received descriptive feedback in form of an expert benchmark, which allowed them to compare their own prescribing decisions with expert recommendations. The recommendations were elicited in a survey of pediatric department directors ( n=20), who stated the length of antibiotic therapies they would choose for the routine cases. Pediatricians’ characteristics were elicited in a comprehensive questionnaire. Results. Providing pediatricians with expert feedback significantly reduced the length of antibiotic therapies by 10% on average. Also, the deviation of pediatricians’ decisions from experts’ recommendations significantly decreased. Antibiotic therapy decisions were significantly related to pediatricians’ clinical experience, risk attitudes, and personality traits. The effect of feedback was significantly associated with physicians’ experience. Conclusion. Our results indicate that descriptive expert feedback can be an effective means to guide pediatricians, especially those who are inexperienced, toward more appropriate antibiotic prescribing. Therefore, it seems to be suitable for inclusion in antibiotic stewardship programs.

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16. SCORE-UC: Antibiotic Stewardship in Urgent Care

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa417.015 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S9-S9

Author(s):

Adam Hersh ◽

Eddie Stenehjem ◽

Nora Fino ◽

Park Willis ◽

Rajendu Srivastava ◽

...

Keyword(s):

Antibiotic Stewardship ◽

Healthcare Delivery ◽

Urgent Care ◽

Antibiotic Prescribing ◽

Intervention Period ◽

First Line ◽

Stewardship Program ◽

Core Elements ◽

Respiratory Conditions ◽

Recommended Therapy

Abstract Background Urgent care (UC) is a rapidly growing site of healthcare delivery. The CDC developed Core Elements for Outpatient Antibiotic Stewardship to guide development of outpatient stewardship but little experience exists in applying Core Elements to UC settings. Our objective was to evaluate the effectiveness of a UC stewardship program in a health system. Figure Methods We designed a UC stewardship program for Intermountain Healthcare’s 39 UC sites based on CDC Core Elements. The pre-intervention period was Aug 2017-June 2019. The intervention period was 12 months from Jul 2019 -June 2020. The program consisted of education for patients/providers about appropriate diagnosis and prescribing for respiratory conditions; media campaigns; EHR tools; and a prescribing dashboard for clinicians. The primary outcome was the percentage of respiratory visits where an antibiotic was prescribed. Secondary outcomes included the percentage of encounters receiving antibiotics for conditions where no antibiotics are indicated (e.g. bronchitis) and the percentage of encounters receiving first-line recommended therapy for conditions in which antibiotics may be warrented (otitis media, sinusitis, and pharyngitis). We used a binomial mixed effects hierarchical model to calculate the odds of antibiotic prescribing associated with the intervention period accounting for pre-intervention trends. Models account for clustering within providers and clinics. We present the results of an interim analysis after 7 months of the intervention. Results The overall number of UC encounters during the study period was 1,559,403 and 41.5% were for respiratory conditions. The percentage of patients with respiratory conditions that received an antibiotic prescription declined from 49.9% pre-intervention to 35.3% during the intervention (OR 0.73, 95% CI: 0.71, 0.76), reaching a low of 30% during February 2020 (Figure). Prescribing for conditions where antibiotics are not indicated decreased (OR 0.31, 95% CI 0.26–0.36) and first line recommended therapy increased (OR 1.28, 95% CI 1.20–1.26) during the intervention. Conclusion After 7 months of a planned 12 month intervention, the UC stewardship program was associated with improved antibiotic prescribing. Disclosures Rajendu Srivastava, MD, AHRQ, NIH, CDC (Grant/Research Support, I hold grants from AHRQ, NIH and CDC for a variety of clinical research and implementation studies)IPASS Patient Safety Institute (Other Financial or Material Support, I am a physician founder of this company to spread handoff best practices and reduce adverse events. My employer holds my equity in this company.)

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