Outpatient Antibiotic Stewardship Program                      

Antibiotic resistance is now widely recognized as a looming threat in healthcare.  By volume, outpatient settings account for 85-90% of antibiotics prescribed in the United States. The Centers for Disease Control and Prevention (CDC) estimates that 30 percent of all antibiotics prescribed in outpatient clinics (e.g. emergency departments, urgent care clinics, primary care practices, community health clinics, specialized outpatients clinics and pharmacies) are unnecessary. As a response to these challenges, the UC Davis Emergency Medicine and Outpatient Antibiotic Stewardship Program was created beginning in the Emergency Department in July 2015 with expansion to the outpatient setting July 2017. Our program has implemented a number of successful interventions to and continues to expand to incorporate evidence-based innovations with the goal of improving quality of care and patient safety around antibiotic use.

Our mission is to serve as a leader in improving antibiotic use and decreasing harm from antibiotics across the healthcare spectrum.   We serve as a venue for sharing best practices, provide expertise and education to health care professionals and patients, and evidence based implementation and evaluation of antibiotic stewardship.

Information for Healthcare Providers

Antimicrobial Stewardship Toolkit 

The Antimicrobial Stewardship Toolkit is a guide for practical implementation in adult and pediatric emergency department and urgent care settings. This guide is written for healthcare providers and administrators interested in designing quality improvement programs in antimicrobial stewardship and outlines how facilities can implement individualized, effective, and practical antimicrobial stewardship programs in acute care (emergency department and urgent care) settings.

The Alliance Working for Antibiotic Resistance Education (AWARE) Compendia Mobile App 

AWARE is a long-term project of the California Medical Association (CMA) Foundation, funded by the Centers for Disease Control and Prevention (CDC) through the California Department of Public Health (CDPH). Working with participating health plan partners, the CMA Foundation is able to identify high prescribers of antibiotics and provide targeted education.

The CMA Foundation launched the AWARE Compendia mobile app containing clinical guidelines for appropriate antibiotic use and providing easy access to the Adult and Pediatric Acute Respiratory Tract Infection Guideline Summaries. As these summaries are updated annually, the mobile app will be updated to provide the most up-to-date information.

The AWARE mobile app is available on Android and iPhone devices. Search “AWARE Toolkit” in the Google Play store and the iTunes store to download the app. The full AWARE toolkit is also available in .pdf form here

Antibiotic Guidelines

UC Davis's Outpatient ASP has developed its own guidelines for the outpatient setting synthesizing local antimicrobial resistance data with national recommendations. 

Educational Materials for Healthcare Professionals

CDC's Be Antibiotics Aware Campaign.    CDC produced materials for healthcare professionals to share with patients, partners and colleagues. Materials include: Brochure, Fact Sheets, Infographics, Return to Day Care Letter, Prescription Pads and Posters. Click here.

Reducing Antibiotic Use in Outpatient Settings (Video).   In this short interview Dr. Larissa May talks about how emergency department doctors can educate patients about inappropriate use of antibiotics. Click here.

Your Role in Using an Antibiotic: Be a Partner in Your Healthcare.   This interactive video teaches patients important information about antibiotics. When they are not needed, antibiotics won’t help you, and the side effects could still hurt you. Learn what antibiotics treat and what they do not treat. Click here.

Food & Drug Administration FDA)'s Educational Resources: Antibiotics and Antibiotic Resistance.    These educational resources provide information on antibiotics and antibiotic resistance. They are intended for use by educators, health care professional and consumers. Click here.

CDC & ACP's Advice for Antibiotic Use for Acute Respiratory Tract Infection in Adults.    Literature review and practical advice for healthcare professionals in managing acute respiratory tract infecitons. Click here. 

Useful Links

Antimicrobial Resistance Maps

Association for Professionals in Infection Control and Epidemiology (APIC)

California Department of Public Health (CDPH) – The California Antimicrobial Stewardship Program Initiative

Center for Infectious Disease Research and Policy (CIDRAP)

Centers for Disease Control and Prevention (CDC) Antibiotic/Antimicrobial Resistance

Food and Drug Administration (FDA) Antimicrobial Resistance

Making a Difference in Infectious Diseases Pharmacotherapy (MAD-ID)

Society of Infectious Disease Pharmacist (SIDP)                                                        

UC Davis Division of Infectious Diseases

Information for Patients

Antibiotics are the medications your doctor prescribes to treat infections caused by bacteria. Since the 1940s, antibiotics have been widely used for reducing illnesses and death from infectious disease and are life saving for serious bacterial infections.  However, the over use of antibiotics over the years have led the infectious organisms, which the antibiotics are designed to kill, to become adapted or resistant to them; making these drugs less effective.

The UC Davis Health Department of Emergency Medicine and UC Davis Health have joined the Centers for Disease Control and Prevention, along with hospitals and healthcare organizations around the country in developing an ‘Antibiotic Stewardship Program’ to help ensure that antibiotics remain as effective as possible. UC Davis has expanded its efforts beyond the requirements to monitor and optimize antibiotic use in hospitals, to include the emergency department and other ambulatory care settings such as primary care physician practices.

What Does This Mean For Our UC Davis Health Patients?

  • Antibiotics are only recommended for some infections, so it is important to use the right one. It is important to note that some infections do not need treatment with an antibiotic drug at all. Taking antibiotics more frequently and for a longer period of time can make you sick. Therefore, UC Davis health is committed to providing sage and appropriate use of antibiotic drugs to ensure the best care of our community. 
  • When antibiotics are not needed, they won’t help you but instead the side effects could hurt you. Common side effects of antibiotics can include rash, dizziness, nausea, diarrhea, or yeast infections. More serious side effects include Clostridium difficile infection (also called C.difficile or C.diff), which causes diarrhea that can lead to severe colon damage and death and can be transmitted to other people in the hospital and in the community. In addition, people can also have severe and life-threatening allergic reactions.
  • Antibiotics are only needed for treating certain infections and are not indicated for the common cold or acute bronchitis. Antibiotics are also not always needed for some common bacterial infections including sinus infections and some ear infections.
  • Antibiotics do not work on viruses, such as colds and flu, or runny nose, even if the mucus is thick, green or yellow.
  • Take antibiotics only as prescribed by a healthcare professional. Do not save leftover antibiotics for future use and do not share them with friends or family.  Different antibiotics treat different infections and for some patients antibiotics can interfere with other medications they may be taking and cause serious harm.  Always consult a healthcare professional if you think you may need an antibiotic.  Ask your physician or healthcare practitioner if an antibiotic is needed or if other treatments will be more effective.

 Additional Resources

The ABC's of Antibiotics

The Other Side of Antibiotics - The Story of Peggy Lillis

Common Illnesses - Which Benefit from Antibiotics and Which Don't?

Viruses or Bacteria - What's Got You Sick?

Preventing and Treating Ear Infections


Our Current Research Activities

In addition to promoting optimal antibiotic use for and outpatient and emergency department patients at UC Davis Health, the Emergency Department and Outpatient Antibiotic Stewardship Program aims to advance the science in the areas of antibiotic resistance and stewardship.  Below are lists of research projects our team have conducted or are ongoing.


A Multifaceted Intervention to Improve Prescribing for Acute Respiratory Tract Infection for Adults and Children in Emergency Department and Urgent Care Settings.                                                                          Funder: Center for Disease Control and Prevention                                                                                              Principle Investigator: Larissa May, MD, MSPH, MSHS                                                                                                  This multisite project will evaluate an outpatient antibiotic stewardship intervention adapted for acute care settings vs. one enhanced with behavioral science interventions to reduce inappropriate antibiotic prescribing for acute respiratory tract infections in a diverse population of adults and children presenting to emergency departments and urgent care centers.

Pilot randomized clinical trial of multi-respiratory pathogen testing versus usual care in emergency department (ED) patients with upper respiratory symptoms.                                                                             Funder: BioFire Diagnostics                                                                                                                                    Principle Investigator: Larissa May, MD, MSPH, MSHS                                                                                                    To prospectively evaluate the effect of rapid, multi-respiratory pathogen molecular testing vs. usual care on the frequency of respiratory pathogen detection, clinical treatment, and outcomes among children and adult patients tested for influenza virus infection being evaluated for influenza like illness and/or respiratory infection in the emergency department (ED) setting.

Evaluation of the Roche Cobas Liat Flu/RSV assay for the management of influenza in the ED.                 Funder: Roche Diagnostics                                                                                                                                      Principle Investigator Larissa May, MD, MSPH, MSHS                                                                                                      To determine if immediate availability of the Roche Liat Assay plus procalcitonin with ED pharmacist intervention optimizes antiviral treatment and reduces antibiotic treatment for pediatric ED patients with suspected influenza v. standard care (Liat Assay) using a prospective, patient-randomized design.

An Emergency Department Specific Antimicrobial Stewardship Intervention to Improve Antibiotic Selection and Duration for Skin and Soft Tissue Infections in Adult and Pediatric Outpatients.                                    Funder: Merck                                                                                                                                                          Principle Investigator: Larissa May, MD, MSPH, MSHS                                                                                                    To assess the effectiveness and acceptability of a multifaceted antimicrobial stewardship intervention geared towards clinicians for reducing inappropriate antibiotic use and duration for SSTI in adult and pediatric patients presenting to the ED.

Physician Compliance with Skin Infection Treatment Guidelines in the Emergency Department: An Evaluation of Scope and Intervention Impact. MAD-ID Antimicrobial Stewardship Research Grant.                    Funder: MAD-ID                                                                                                                                                        Principle Investigator: Miller and Larissa May, MD, MSPH, MSHS

DHS/UCLA/USC Implementation Science Pilot Program.                                                                                  Principle Investigator: Yadav                                                                                                                                            Co-Investigator:  Larissa May, MD, MSPH, MSHS

Using Behavioral Science to Reduce Inappropriate Antibiotic Use in Acute Care Settings.                                  Co-Investigator: Larissa May, MD, MSPH, MSHS

Improving Quality & Equity of Emergency Care Decisions (IQED).                                                                    Funder: National Institute of Health (NIH) – National Institute on Aging (NIA)                                                    Principle Investigator: Meeker, Daniella                                                                                                                        With rising concern about diagnostic failure and patient safety and optimizing resource use, the proposed study will provide crucial evidence that will expand the depth and breadth of knowledge of factors underlying diagnostic failure in emergency care.  Learn more.

Creation of a Generalizable ED-based Antimicrobial Stewardship Program Using Electronic Health Record Clinical Decision Support.                                                                                                                                        Funder: National Institute of Allergy and Infectious Diseases (NIAID)                                                                  Principle Investigator: Mistry                                                                                                                                Consultant: Larissa May, MD, MSPH, MSHS                                                                                                                  This PECARN study seeks to develop ED specific prototype decision support for antimicrobial stewardship for pediatric UTI and Pneumonia. Learn more.

Team Members

Larissa May, MD, MSPH, MSHS                                                                                                                            Professor, Department of Emergency Medicine                                                                                                  Director of Emergency Department Antibiotic Stewardship                                                                                        UC Davis Medical Center                                                                                                                                            Read full profile

Natasha A. Nakra, MD, MS                                                                                                                                      Clinical Assistant Professor, Pediatric Infectious Disease Specialist                                                                          UC Davis Medical Center                                                                                                                                            Read full profile  

Kabir Yadav, MSHS, MDCM, FACEP                                                                                                                          Associate Professor, Department of Emergency Medicine                                                                                    UCLA Medical Center                                                                                                                                                      Read full profile

Rakesh Mistry MD, MS                                                                                                                                                        Associate Professor, Pediatrics-Emergency Medicine                                                                                                      Director of Research                                                                                                                                                            Children’s Hospital Colorado                                                                                                                                     Read full profile

Daniella Meeker, PhD                                                                                                                                                    Assistant Professor of Preventive Medicine                                                                                                          Director of Clinical Research Informatics                                                                                                                    Keck School of Medicine of University of Southern California                                                                                Read full profile

Jason Doctor, PhD                                                                                                                                                            Associate Professor, Price School of Public Policy                                                                                                  Chair, Department of Health Policy and management, Price School of Public Policy                                            Director of Health Informatics, Schaeffer Center                                                                                                  Norman Topping Chair in Medicine and Public Policy                                                                                              Read full profile

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