# Every prescription counts: rethinking outpatient antibiotic stewardship in Abu Dhabi, United Arab Emirates

## TL;DR

This paper discusses the growing issue of antibiotic misuse in outpatient settings in Abu Dhabi and proposes a multi-level framework to improve antibiotic stewardship and combat antimicrobial resistance.

## Contribution

The paper introduces a novel multi-level framework for outpatient antibiotic stewardship tailored to Abu Dhabi, informed by regional AMR trends and lessons from the COVID-19 pandemic.

## Key findings

- Antimicrobial resistance is increasing in the UAE despite existing stewardship initiatives.
- Outpatient antibiotic stewardship is underdeveloped, leading to inappropriate prescriptions and community-acquired infections.
- A multi-level framework is proposed to optimize outpatient antibiotic use and improve surveillance.

## Abstract

Antimicrobial resistance (AMR) is a persistent global health challenge that is associated with morbidity, mortality, and healthcare costs. In most outpatient (OP) settings, such as emergency rooms, primary and specialty care clinics, and dental clinics, antibiotics are often inaccurately prescribed due to patient expectations, empirical decision-making, and limited access to diagnostic data. Despite existing national frameworks, surveillance systems, and stewardship initiatives, resistance among key pathogens in the United Arab Emirates (UAE), a part of the World Health Organization’s (WHO’s) Eastern Mediterranean Region (EMR), is increasing. Many OP settings are underdeveloped, as most efforts focus on hospital inpatients, leading to inappropriate antibiotic use, the promotion of resistant pathogens, and an increased risk of community-acquired infections. Intensifying antimicrobial stewardship (AMS) practices in OP settings brings an opportunity to enhance patient care, limit unnecessary prescriptions, prevent adverse reactions, and reduce healthcare costs. This perspective provides insights into regional AMR trends in the EMR, reviews existing governance, regulatory frameworks, and surveillance systems of the UAE, and identifies gaps with OP stewardship practices in the Emirate of Abu Dhabi. It recommends a multi-level framework to support optimisation of OP antibiotic use, guided by regional trends, current practice, and lessons learnt from the COVID-19 pandemic. By adopting this framework, current stewardship efforts can be strengthened, responsible antibiotic use promoted, and surveillance improved, progressing towards a coordinated, multi-sector strategy to preserve antimicrobial efficacy and sustain long-term progress against resistance.