Outpatient Antibiotic Stewardship: A Growing Frontier—Combining Myxovirus Resistance Protein A With Other Biomarkers to Improve Antibiotic Use

Joseph, Patrick; Godofsky, Eliot

A major obstacle to effective outpatient antibiotic stewardship and appropriate antibiotic prescribing is the difficulty in accurately defining the microbial cause of respiratory infections, especially distinguishing viral from bacterial etiology. This diagnosis is even more challenging when rapid tests identify bacterial pathogens present in the carrier state. Additionally, attempts to differentiate bacterial from viral infections using only the history and physical findings are inaccurate about one-half of the time [64] . Patients may also have symptoms mimicking an infectious process, which is actually caused by hypersensitivity, especially rhinovirus and coronavirus acting directly as allergens, eliciting an IgE elevated response. This may lead to low-grade fevers and exacerbation of reactive airway disease in predisposed patients with a history of underlying allergies, atopy, asthma, or COPD [68, 69] . Lastly, patient expectations of therapy present another challenge to overcome in the outpatient setting. In 1 study, up to 50% of parents had a previsit expectation of receiving an antibiotic [70] . When patients expect or demand antibiotics, they are more likely to receive them even though patients' satisfaction may not be affected by prescribing of antibiotics [53] .