Antimicrobial stewardship in the primary care setting: from dream to reality?

BMC Fam Pract. 2020 Jul 8;21(1):134. doi: 10.1186/s12875-020-01191-0.


Background: Clinicians who work in primary care are potentially the most influential healthcare professionals to address the problem of antibiotic resistance because this is where most antibiotics are prescribed. Despite a number of evidence based interventions targeting the management of community infections, the inappropriate antibiotic prescribing rates remain high.

Discussion: The question is how can appropriate prescribing of antibiotics through the use of Antimicrobial Stewardship (AMS) programs be successfully implemented in primary care. We discuss that a top-down approach utilising a combination of strategies to ensure the sustainable implementation and uptake of AMS interventions in the community is necessary to support clinicians and ensure a robust implementation of AMS in primary care. Specifically, we recommend a national accreditation standard linked to the framework of Core Elements of Outpatient Antibiotic Stewardship, supported by resources to fund the implementation of AMS interventions that are connected to quality improvement initiatives. This article debates how this can be achieved. The paper highlights that in order to support the sustainable uptake of AMS programs in primary care, an approach similar to the hospital and post-acute care settings needs to be adopted, utilising a combination of behavioural and regulatory processes supported by sustainable funding. Without these strategies the problem of inappropriate antibiotic prescribing will not be adequately addressed in the community and the successful implementation and uptake of AMS programs will remain a dream.

Keywords: Antibiotic stewardship; Antimicrobial; Antimicrobial stewardship; resistance; primary care; outpatient setting..

MeSH terms

  • Ambulatory Care* / economics
  • Ambulatory Care* / legislation & jurisprudence
  • Anti-Bacterial Agents / therapeutic use*
  • Antimicrobial Stewardship* / methods
  • Antimicrobial Stewardship* / organization & administration
  • Decision Support Systems, Clinical
  • Drug Resistance, Microbial
  • Guideline Adherence
  • Humans
  • Inappropriate Prescribing / prevention & control*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / standards
  • Primary Health Care* / methods
  • Primary Health Care* / organization & administration
  • Primary Health Care* / standards


  • Anti-Bacterial Agents