Antibiotic Stewardship For Upper Respiratory Infections In Acute Care Ambulatory Settings

Authors

• Demet Saygili, University of LynchburgFollow

Specialty

Urgent Care

Abstract

Upper respiratory infections (URIs) are the leading cause of visits to urgent care, primary care, and emergency departments (acute ambulatory care). Despite their predominantly viral etiology, antibiotics are frequently prescribed inappropriately. This review evaluates the impact of stewardship interventions on antibiotic prescribing for URIs in acute ambulatory care settings and identifies persistent implementation gaps. Evidence was synthesized from multicenter studies, systematic reviews, randomized controlled trials, and quality-improvement initiatives. Findings indicate that structured interventions, including clinician and patient education, electronic health record (EHR) alerts, benchmarking dashboards, delayed prescription strategies, and audit-and-feedback mechanisms, significantly reduce inappropriate antibiotic use. These reductions occur without compromising patient satisfaction or clinical outcomes. Despite these improvements, challenges continue to persist, including diagnostic uncertainty, patient expectations, workflow constraints, higher prescribing rates in virtual urgent care, and inequities across patient populations. Achieving appropriate antibiotic use requires context-specific interventions that align with telemedicine workflows, support clinician engagement, and include routine monitoring of prescribing patterns. Overall, structured stewardship initiatives in acute ambulatory care settings can meaningfully reduce inappropriate antibiotic prescribing, improve care quality, and help mitigate antimicrobial resistance. Continued system-level commitment is necessary to address ongoing implementation challenges.

Keywords: Upper respiratory infections, Antibiotic stewardship, Ambulatory care, Urgent care, Primary care, Emergency department, Inappropriate antibiotic use, Telemedicine, Delayed prescription, Clinical workflow, Antimicrobial resistance

Recommended Citation

Saygili D. Antibiotic Stewardship For Upper Respiratory Infections In Acute Care Ambulatory Settings. University of Lynchburg DMSc Doctoral Project Assignment Repository. 2026; 8(1).