Metrics of antibiotic prescription or consumption to support antibiotic stewardship in the outpatient healthcare setting: A protocol for a scoping review

Abstract Introduction: Qualitative and quantitative metrics are needed to assess antibiotic consumption and prescription in the context of improving antibiotic stewardship programs in outpatient healthcare settings. This project aims to answer the research question "What metrics evaluate antibiotic prescription and consumption in the outpatient setting?" and to assemble an updated compilation of literature mentioning such metrics. Methods: A scoping literature review will be conducted, following the PRISMA-guidelines and Joanna Briggs Institute methodology. Inclusion criteria will be: Studies that are performed in the outpatient setting, addressing systemic antibacterials, and using quantitative or qualitative metrics or proxy indicators as an outcome. The search strategy will focus on the databases Medline and Embase (via Ovid). Consecutively, two independent reviewers will perform the two screening phases (title-abstract screening and full-text screening), before the metrics will be extracted. Results: Eligible studies will be presented in a PRISMA flowchart, and the findings will be described narratively. The collected metrics will be clustered into suitable categories. Discussion: This scoping review will synthetize metrics that assess antibiotic consumption and prescriptions in the outpatient setting, considering different levels of data aggregation such as healthcare provider level, regional and national trends. It will be the first stepping stone to develop a core outcome set of such metrics for the ambulatory care setting in Switzerland to support and improve antibiotic stewardship.