Less is more: evaluating the impact of transitions of care pharmacist-led optimization on discharge antibiotic therapy duration in the emergency department.

Background: Patients discharged from emergency departments (ED) with antibiotics for common infections often receive unnecessarily prolonged durations, representing a target for transition of care (TOC) antimicrobial stewardship intervention.

Methods: This study aimed to evaluate the effectiveness of TOC pharmacists' review on decreasing the duration of discharge oral antibiotics in patients discharged from the ED at an academic medical center. Pharmacist interventions were guided by an antibiotic duration of therapy guidance focused on respiratory, urinary, and skin infections developed and implemented by the antimicrobial stewardship program.