Effects of a Diagnostic Stewardship Intervention to De-Implement Widespread Use of a Rapid Respiratory Multiplex PCR Test.
This retrospective study evaluated a diagnostic stewardship intervention to reduce widespread, unrestricted use of a rapid multiplex respiratory PCR panel. The health system implemented a selective use strategy that removed the RPP order from the EHR, requiring Infectious Diseases approval. The intervention produced an immediate, sustained 96% reduction in weekly RPP testing over the following year. The authors interpret this as evidence the RPP was providing little incremental clinical value in lower-acuity ambulatory settings. Clinical implications: This study offers fairly direct, actionable guidance for urgent care, reinforcing that broad multiplex respiratory panels add little diagnostic or management value for most patients presenting with routine respiratory. Broad RPP testing should be reserved for atypical, complex, or diagnostically uncertain presentations rather than used routinely. Full Access: ASM Journal
Antimicrobial and Diagnostic Stewardship: Opportunities for Return of Investment
This cost analysis quantifies the ROI of its Antimicrobial Stewardship Program (ASP), diagnostic stewardship, and sustainability efforts. Using institutional cost data and literature-based extrapolation, the authors estimated total annual savings of nearly $5 million, driven mainly by direct drug cost savings and reduced multidrug-resistant gram-negative infections. Clinical implications: Guideline-concordant, narrow-spectrum antibiotic selection and appropriate treatment durations reduce both cost and resistance risk. The high success rate of penicillin allergy de-labeling (97%) supports routinely reassessing reported allergies rather than defaulting to broader-spectrum alternatives. Full access: PubMed
Amoxicillin-Clavulanate vs Amoxicillin for Acute Sinusitis in Adults
This nationwide retrospective cohort study showed no difference in treatment failure between the two groups, and failure resulting in an emergency department or inpatient encounter was rare. Overall antibiotic-associated adverse events did not differ, but secondary infections (yeast and C difficile) were slightly more common with amoxicillin-clavulanate. Clinical implications: Standard-dose amoxicillin is the preferred empiric therapy for uncomplicated adult acute sinusitis without recent antibiotic exposure, given comparable efficacy, fewer secondary infections, and antimicrobial stewardship benefits. Reserve amoxicillin-clavulanate for higher-risk scenarios. Full Access: JAMA
Doxy-PEP Poses Potential Antibiotic Stewardship Challenges in Europe
A modelling study published in Eurosurveillance has quantified the potential contribution of doxy-PEP to overall antibiotic consumption among men who have sex with men (MSM) on HIV pre-exposure prophylaxis (PrEP) in the European Union and European Economic Area (EU/EEA), suggesting a modest but non-negligible additional antibiotic exposure in the context of EU targets to reduce antibiotic use by 20% by 2030. Whilst doxy-PEP has the potential to prevent some STIs, the authors emphasized the importance of tracking its uptake, monitoring changes in STI rates, and assessing whether bacteria are becoming less sensitive to antibiotics so that balanced decisions can protect both individual health and the long-term usefulness of antibiotics for everyone. Clinical implications: Clinicians should be informed about criteria for prescribing these medications and update prescribing patterns based on evidence-based guidance. Full Access: Eurosurveillance