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The goal is not simply to avoid antibiotics but to use them in a judicious manner. Here are 10 steps family physicians, practices, and leaders can take.

Fam Pract Manag. 2021;28(6):15-20

This content conforms to AAFP criteria for CME.

Author disclosures: no relevant financial affiliations.

Writing an antibiotic prescription is a common task for family physicians. In ambulatory settings, approximately 20% of pediatric visits1 and 10% of adult visits2 result in an antibiotic prescription. While antibiotics can save lives, inappropriate or unnecessary use may exacerbate existing antibiotic resistance. According to the Centers for Disease Control and Prevention (CDC), nearly 3 million antibiotic-resistant infections and more than 35,000 consequent deaths happen each year in the United States.3

The CDC published its first Antibiotic Resistance Threats in the United States report in 2013, highlighting key bacterial and fungal threats and providing an action plan to combat their spread. Since then, awareness of antibiotic resistance has grown among health professionals, as well as the public. Antibiotic stewardship programs are now the norm in health care, though much of the focus remains on hospital-based interventions even though more than 60% of antibiotic expenses in the U.S. are incurred in outpatient settings.4

Family physicians are critical and well-positioned to lead the antibiotic stewardship movement for a few simple reasons. First, we write more antibiotic prescriptions than any other medical specialty — about one-fifth of all outpatient antibiotics prescribed each year.5 As the highest-volume prescribers of antibiotics, improving our prescribing habits would have significant health implications for our patients. Second, family physicians train and practice across multiple health care settings (e.g., ambulatory clinics, urgent care centers, nursing homes, and hospitals) in partnership with other specialty physicians. With such diverse roles and practice settings, family physicians are uniquely positioned to amplify the cultural change needed to curb antibiotic resistance. Finally, and perhaps most importantly, the relationship and trust between family physicians and their patients make the primary care visit an ideal venue to educate patients about antibiotic stewardship.

So how can we start improving antibiotic prescribing? This article offers a few suggestions for three key groups — individual family physicians, practices, and leaders.


  • While antibiotics can save lives, inappropriate or unnecessary use may exacerbate existing antibiotic resistance.

  • Family physicians are critical to antibiotic stewardship, in part because they write about one-fifth of all outpatient antibiotic prescriptions each year.

  • Family physicians can ensure appropriate use of antibiotics by leveraging clinical decision support applications, improving patient communication skills, offering delayed antibiotic prescriptions, and using standardized order sets, among other strategies.

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