Raising the Bar on Antibiotic Stewardship

November 18, 2025

Each November, U.S. Antibiotic Awareness Week reminds us that the fight against antimicrobial resistance affects us all.

When it comes to healthcare settings, especially in long-term care and senior living, this focus is especially vital. Antibiotics are among the most commonly prescribed drugs in nursing homes, yet studies show that 40–75% of those prescriptions may be inappropriate.

Why Antibiotic Stewardship Matters
The Centers for Disease Control and Prevention (CDC)’s 2025 theme, “Fighting Antimicrobial Resistance Takes All of Us,” reinforces that we all share responsibility: clinicians, patients, families, and care facilities alike.

Overuse and misuse of antibiotics drive the rise of pathogens that evolve to resist treatment. In nursing homes, effective antibiotic stewardship is essential to quality care, resident safety, and sustainable outcomes.

What Works: Best Practices & Communication
CDC recommends a four-part communication framework to guide conversations about antibiotic use, especially with residents and families. These steps include:

  • Step 1: Review relevant information, such as symptoms or physical examination findings that support the decision about appropriate testing and antibiotic use.
  • Step 2: Deliver a clear diagnosis that explains the change in the resident’s condition.
  • Step 3: When an antibiotic is not needed, FIRST provide a negative treatment recommendation that “rules out” the need for antibiotics. THEN provide a positive recommendation for further evaluation, management, and monitoring.
  • Step 4: Outline a contingency plan that details what actions will be taken if the resident does not improve or if their condition worsens.

Promoting Antibiotic Stewardship in Long-Term Care
Effective antibiotic stewardship in post-acute and long-term care settings relies on a structured approach that integrates leadership commitment, accountability, and expert drug knowledge with actionable policies, rigorous tracking, feedback loops, and staff education. Key core elements of antibiotic stewardship include:

  • Leadership Commitment: Demonstrate facility-wide support for safe, appropriate antibiotic use.
  • Accountability: Identify specific physician, nursing or pharmacy leads who are responsible for stewardship activities.
  • Drug Expertise: Ensure access to individuals with antibiotic-stewardship or infectious-disease training to support prescribing practices.
  • Action: Implement at least one policy or practice to improve antibiotic use—such as antibiotic review or the “time-out” process.
  • Tracking: Monitor process measures (e.g., documentation of dose, indication) and outcome measures (e.g., DOT, antibiotic starts) to guide improvements.
  • Reporting: Provide regular feedback on antibiotic use and resistance patterns to the clinical and nursing staff.
  • Education: Deliver targeted educational resources to providers, nursing staff, residents and families about antibiotic resistance and appropriate use.

By embedding stewardship practices such as “antibiotic time-outs,” monitoring both antibiotic use and outcomes (e.g., C. difficile rates), and providing targeted education to clinicians, nurses, residents and families, facilities can reduce adverse events, curb resistance, and improve patient outcomes.

CDC Antibiotic Stewardship Resources

Resources from Pathway Health

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