Antibiotic Use and Stewardship in the United States

Outpatient antibiotic use

National outpatient antibiotic prescriptions dispensed by U.S. retail pharmacies are reported yearly by state, age, sex, and antibiotic class.

In 2025, the overall outpatient antibiotic prescribing rate was 699 prescriptions per 1,000 population, representing a 7% decline from 2024 (Figure 1). This continues the trend reported in the past several years.

In 2025, the most prescribed antibiotic classes were penicillins (22%), macrolides (22%), and cephalosporins (16%) (Figure 2). Additional prescribing data by demographic characteristics, state, and antibiotic class are available through the Antimicrobial Resistance & Patient Safety Portal and Antibiotic Use in the United States.

The Antimicrobial Resistance & Patient Safety Portal includes Medicare Part D antibiotic prescribing data among people enrolled in Medicare prescription drug coverage, most of whom are older adults, and helps identify stewardship opportunities in this population.

In 2024, the antibiotic prescribing rate among Medicare beneficiaries was 1,372 prescriptions per 1,000 enrollees, a 2% increase from 2023 (Figure 3).

In addition to geography and antibiotic class, these data are also reported by clinician specialty (Figure 4). Nurse practitioners (21%), family practice physicians (17%), internal medicine physicians (15%), and physician associates (11%) accounted for 63% of the antibiotic prescriptions among Medicare Part D beneficiaries.

Hospital antibiotic use

The National Healthcare Safety Network (NHSN) Antimicrobial Use and Resistance Module – Antimicrobial Use (AU) Option allows U.S. acute care hospitals to monitor and compare their antibiotic use with other hospitals. The Standardized Antimicrobial Administration Ratio (SAAR) is a risk-adjusted summary measure available to hospitals that participate in the NHSN AU Option.

Each year, the NHSN AU Option Data Report provides updated SAAR data and summarizes antibiotic use and SAAR distributions by patient care location and antibiotic category. These data can help hospital stewardship teams monitor antibiotic use, identify areas that may need further review, and target stewardship efforts. Data are also available through the Antimicrobial Resistance & Patient Safety Portal, where users can explore and visualize SAAR distributions at the national and state levels.

Hospitals continue to submit data to the NHSN AU Option to meet the Centers for Medicare & Medicaid Services (CMS) Promoting Interoperability Program reporting requirements.

In 2026, CDC released updated SAAR baselines derived from 2023 data and additional resources to support interpretation and use of SAAR data. These updates help hospitals interpret SAAR data against more current benchmarks and identify opportunities to improve antibiotic stewardship.

Hospital antibiotic stewardship

CDC assesses implementation of the Core Elements of Hospital Antibiotic Stewardship Programs through the NHSN Patient Safety Component Annual Hospital Survey. Hospital staff complete annual survey questions about each of the seven Core Elements. CDC reports the percentage of hospitals meeting the Core Elements by year and state.

The Priorities for Hospital Core Element Implementation are derived from six of the seven Core Elements to enhance the quality and impact of hospital stewardship programs (Figure 5). In 2025, 20% of hospitals met all six Priorities, compared to 16% in 2024.

Long-term care antibiotic stewardship core elements

The implementation of the antibiotic stewardship Core Elements in long-term care facilities is assessed through the NHSN Long Term Care Facility Component—Annual Facility Survey. Facility staff complete annual survey questions that assess the uptake of CDC's Core Elements. CDC reports the percentage of long-term care facilities meeting the Core Elements by year and state.

Updated CDC Core Elements of Outpatient Antibiotic Stewardship Programs

CDC updated the Core Elements of Outpatient Antibiotic Stewardship to reflect new evidence and changes in outpatient healthcare delivery. Key updates include:

• The guidance emphasizes health system leadership, infrastructure, and resources to support stewardship across outpatient care.
• The framework aligns with the seven Core Elements used for hospital stewardship programs, providing a consistent approach across healthcare settings.
• New implementation tools, including priority activities, measurement resources, and an assessment checklist, help organizations establish and strengthen stewardship programs.
• Setting-specific appendices provide stewardship considerations for different outpatient settings, including dentistry, telemedicine, and dialysis.

The updated Core Elements provide a flexible framework to help health systems and outpatient practices improve antibiotic use and strengthen stewardship efforts in outpatient care.

Emergency department visits for antibiotic-associated adverse drug events in children1

CDC evaluated emergency department (ED) visits for antibiotic-associated adverse drug events among U.S. children from 2019 to 2023. Findings include:

• Antibiotics were implicated in more than one-third of pediatric ED visits for adverse drug events.
• An estimated 47,600 ED visits occurred each year, increasing to about 73,100 visits in 2023.

These findings reinforce that optimizing antibiotic use is an important strategy to reduce preventable antibiotic-related harms in children and improve patient safety.

Amoxicillin-Clavulanate vs. Amoxicillin for acute sinusitis in adults2

Researchers compared treatment outcomes among adults with uncomplicated acute sinusitis who received amoxicillin-clavulanate or amoxicillin. Key findings include:

• Treatment failure was uncommon and did not differ between treatment groups.
• Antibiotic-associated adverse events were similar overall, but patients receiving amoxicillin-clavulanate had a higher risk of yeast infections and Clostridioides difficile infection.

These findings support standard-dose amoxicillin as a first-line treatment for uncomplicated acute sinusitis. Using the narrowest effective antibiotic reduces antibiotic-related harms while achieving similar clinical outcomes.

Antibiotic prescribing among advanced practice clinicians3

CDC evaluated changes in outpatient antibiotic prescribing by advanced practice clinicians (nurse practitioners and physician associates) and physicians from 2011 to 2022. Key findings include:

• Advanced practice clinicians accounted for an increasing share of outpatient antibiotic prescriptions, rising to about one in three prescriptions in 2022, and more than doubled their rate per capita compared to 2011.
• Growth in prescribing by nurse practitioners was especially pronounced in rural areas and several Southeastern states.
• Broad-spectrum antibiotic prescribing was more common in rural areas.

These findings highlight the importance of engaging advanced practice clinicians in efforts to improve antibiotic prescribing and expanding antibiotic stewardship in rural care.

Telehealth antibiotic stewardship resources

The Agency for Healthcare Research and Quality (AHRQ) has developed a toolkit for antibiotic stewardship in telemedicine to help healthcare organizations establish and strengthen stewardship programs in virtual care settings. Similar to AHRQ's existing stewardship toolkits for hospitals, long-term care, and outpatient care, the telehealth resources are designed to support implementation through practical guidance, tools, and strategies.

Dental antibiotic stewardship resources

Dentists account for approximately 10% of outpatient antibiotic prescribing in the United States, and studies have identified opportunities to improve prescribing. CDC developed these resources to support antibiotic stewardship in dental care settings.

Antibiotic Stewardship Strategies Outpatient Dental Settings: This appendix describes factors that influence dental antibiotic prescribing and highlights strategies for adapting the Core Elements of Outpatient Antibiotic Stewardship Programs to improve prescribing practices in dentistry.

Hospital antimicrobial use and stewardship, 20234

CDC evaluated antimicrobial use and antimicrobial stewardship practices in U.S. hospitals in 2023 and compared findings with the 2015 national prevalence survey. Key findings include:

• Nearly all participating hospitals (99%) had an antimicrobial stewardship program, compared with 79% in 2015.
• About half of hospitalized patients (50%) received at least one antimicrobial, similar to findings from 2015.
• Antimicrobial prescribing patterns changed, including decreased use of fluoroquinolones and increased use of third- and fourth-generation cephalosporins.
• Antimicrobial use also shifted across patient care areas, with decreases in neonatal intensive care units and increases in mother–baby units.

These findings show that while overall hospital antimicrobial use remained stable, prescribing practices have evolved over time. Continued surveillance helps identify opportunities to improve antibiotic use, enhance patient safety, and address antimicrobial resistance.

Improving antibiotic stewardship for community-acquired pneumonia

Community-acquired pneumonia (CAP) is one of the most common reasons antibiotics are prescribed in hospitalized patients. This section highlights CDC-supported efforts to improve antibiotic stewardship for hospitalized adults with CAP.

• Electronic Clinical Quality Measures for Antibiotic Use in Uncomplicated Community-Acquired Pneumonia:5 CDC-supported researchers developed and validated two electronic clinical quality measures (eCQMs) that identify unsupported excess antibiotic duration and inappropriate broad empiric antibiotic use in hospitalized adults with uncomplicated CAP.
  
  • The measures were endorsed with conditions by the Partnership for Quality Measurement and included on the Centers for Medicare & Medicaid Services (CMS) 2025 Measures Under Consideration (MUC) list.
  • The published study demonstrated that the measures are reliable, valid, and feasible for assessing antibiotic use and can support hospital antibiotic stewardship programs.
    

• Diagnostic Stewardship for Community-Acquired Pneumonia: CDC-funded studies examined how diagnostic stewardship interventions can improve antibiotic use among hospitalized patients with suspected CAP.
  • Among hospitalized adults receiving antibiotics for suspected community-acquired respiratory infection, stewardship-guided interpretation of procalcitonin and respiratory virus test results reduced antibiotic use in the hospital by an average of 4.1 days compared with usual care. 6
  • Among hospitalized patients with possible CAP and positive respiratory viral test results, clinical outcomes were similar whether patients received 0–2 days or 5–7 days of antibiotics. 7
  • These findings highlight how diagnostic stewardship can support appropriate antibiotic use by helping clinicians interpret diagnostic information and reassess antibiotic therapy.

Improving antibiotic use at hospital discharge 8

CDC-funded researchers evaluated whether prospective audit and feedback by antibiotic stewardship teams could reduce unnecessary antibiotic use at hospital discharge across 10 U.S. hospitals. Key findings include:

• Overall antibiotic prescribing at hospital discharge did not decrease following implementation of the intervention.
• Antibiotic duration, hospital length of stay, and 30-day readmission rates were similar before and after the intervention.
• Among patients with common, uncomplicated infections, the intervention improved optimal antibiotic prescribing at hospital discharge.

These findings highlight the challenges of improving antibiotic prescribing at hospital discharge. Developing and evaluating effective stewardship strategies during transitions of care remains a CDC priority to improve antibiotic use and patient safety.

Medicaid toolkit supplement

CDC developed a Medicaid Toolkit Supplement to help state Medicaid programs and health departments effectively collaborate on outpatient antibiotic stewardship activities. Designed to be paired with the previously published payer toolkit, it includes:

• Background information on Medicaid programs and outpatient antibiotic stewardship.
• Examples of successful Medicaid-health department stewardship initiatives from six states to provide tangible collaboration strategies.
• Considerations for effective collaboration between Medicaid programs and health department antibiotic stewardship experts.

Expanding access to antibiotic stewardship resources in Colorado9

Children's Hospital Colorado and Denver Health, in collaboration with the Colorado Department of Public Health and Environment, launched free mobile and web-based antibiotic stewardship resources through Firstline in October 2023. The resources provide pediatric and adult treatment guidelines, antibiotic dosing information, and pathogen information to support clinicians across Colorado, including those in rural and smaller hospitals with limited access to stewardship expertise. An evaluation through December 2025 found:

• The mobile resources reached 4,409 users in Colorado during the first year.
• Use remained consistent, averaging 871 active users per month across the mobile and web platforms.
• Most survey respondents reported improved knowledge of antibiotic selection and dosing, and all supported continued availability of the resources.

From July 1, 2025, to July 31, 2026, CDC's antibiotic use website garnered 683,000+ page views with a significant spike in April 2026 accounting for 10k+ page views. The most viewed webpage was Healthy Habits: Antibiotic Do's and Don'ts, contributing to 13% of total page views. During this timeframe, there were 176,659 material downloads with The Core Elements of Hospital Antibiotic Stewardship Programs being the most downloaded PDF. From November 2025 to January 2026, there were 6,178 page views of the Be Antibiotics Aware partner toolkit during U.S. Antibiotic Awareness Week promotion.

Social media remains a highly effective tool for reaching and engaging Be Antibiotics Aware consumer and healthcare professional audiences across a variety of social media platforms. Social media content shared during U.S. Antibiotic Awareness Week (USAAW) promotion (November 14-24, 2025) generated 4,941 impressions and a 1.5% engagement rate across 10 posts. From September 1 to November 30, 2025, antibiotic use content generated 8,904 impressions and 141 engagements.

CDC's Be Antibiotics Aware educational effort offers a variety of educational materials for both healthcare professionals and the general public. These resources are organized by material type, intended audience, and healthcare setting.