The short answer: Not every case of cough, sore throat, or fever requires antibiotics. Before prescribing, establish a working diagnosis, assess for severity signs, check allergies and current medicines, consider testing when the result could change management, and clearly document how to take the medicine and when to reassess. Patients should not self-purchase, reuse, or share antibiotics.
This article is intended for outpatient clinics and patients who are new to the topic. It is educational material and does not replace a clinical examination or an individualized treatment regimen. Treatment decisions should take into account age, pregnancy, underlying conditions, allergies, kidney and liver function, current medicines, local resistance patterns, and the current professional guidance applicable where care is provided.
Checklist before the patient leaves the clinic
- Working diagnosis: Has the prescriber explained whether the illness is likely to be caused by bacteria, a virus, or another cause?
- Reason for using or not using antibiotics: Does the patient understand the expected benefits, limitations, and main risks?
- Clear prescription: Does it state the medicine’s name, strength, dose, dosing interval, duration, and what to do if a dose is missed?
- Safety information: Have relevant allergies, current medicines, underlying conditions, pregnancy, or breastfeeding been checked?
- Follow-up plan: When should the patient contact the clinic, return for review, or seek emergency care?
- Post-prescribing responsibility: Who will review test results, receive feedback, and manage the case if the patient does not improve?
If anything is unclear, the patient should ask before leaving. The clinic can incorporate this checklist into the consultation form, prescribing software, or discharge instructions.
Antibiotics treat bacterial infections, not viral infections
Antibiotics do not treat viral illnesses such as the common cold. Taking them without an indication can still cause diarrhoea, rash, drug interactions, serious allergic reactions, and contribute to antibiotic resistance. Antibiotics are also a common cause of medication-related emergency department visits among children (according to cdc.gov).
Conversely, the principle of “do not use antibiotics when they are unnecessary” should not become a reason to refuse treatment independently. Some bacterial infections require assessment and antibiotic treatment to reduce the risk of complications or improve symptoms. Sputum or nasal-discharge colour is not enough to conclude on its own that antibiotics are needed; the decision should be based on the history, examination, appropriate testing, and the course of illness.
A five-step process for outpatient clinics
1. Define the clinical problem before opening the prescription
Healthcare staff should record:
- The main symptoms, when they began, and their course: improving, persistent, or worsening after an initial improvement.
- Vital signs and warning signs requiring referral or emergency care.
- Underlying conditions, immunocompromised status, recent infections, and previous courses of antibiotics.
- Drug allergies, especially a history of anaphylaxis or severe cutaneous reactions.
- Prescription medicines, over-the-counter medicines, dietary supplements, and factors that could cause interactions.
Write a working diagnosis rather than simply documenting “infection.” For example, “acute pharyngitis; assess for group A streptococcal infection and test when appropriate” is more useful than “sore throat—prescribe antibiotics.” This wording helps the prescriber state the basis for the decision.
2. Order tests only when the results could change management
Testing is not always necessary, but it should not be omitted when the history and clinical examination are insufficient to distinguish the cause. In sore throat, clinical findings alone do not always distinguish group A streptococcal pharyngitis from viral pharyngitis; a rapid antigen detection test may be considered according to clinical criteria and the guidance used at the facility (according to cdc.gov).
The clinic should clearly define:
- Who is authorized to order tests, and which tests are used?
- How will a negative or positive result change management?
- Who is responsible for reviewing the result, informing the patient, and adjusting the plan?
- When is culture, additional testing, or referral to a facility with greater diagnostic capacity required?
Too little testing can lead to presumptive prescribing; unnecessary testing can produce results that are difficult to interpret and lead to inappropriate treatment. For this reason, diagnostic stewardship should be implemented alongside antibiotic stewardship.
3. When indicated, choose an antibiotic according to guidance and patient characteristics
The prescription should be based on current treatment guidance, local resistance data where available, and the patient’s characteristics. A “stronger” drug is not necessarily a better choice. Consider the spectrum of activity, risk of adverse effects, interactions, likely adherence, previous medication exposure, and kidney and liver function when relevant.
The clinic should standardize decision pathways in its software or internal materials, including:
- Criteria for identifying patients who may need antibiotics.
- First-line options and alternatives in cases of allergy or contraindication.
- The dose, dosing interval, and treatment duration specified by the professional guidance used at the facility.
- Criteria for not prescribing, delaying treatment with monitoring, or referring the patient.
- What to do if the patient does not improve, develops adverse effects, or the initial diagnosis is no longer appropriate.
Do not copy a foreign treatment regimen for every situation. CDC materials primarily reflect the United States context; facilities in Vietnam should prioritize guidance from the Ministry of Health, relevant professional societies, and resistance data appropriate to the local setting.
4. Communicate so the patient understands the decision
An effective discussion should answer three questions: What is the likely illness? Why are antibiotics being used or not used? What happens next? The following sequence can help:
- State the assessment: “The current signs are more consistent with a viral respiratory infection.”
- Explain the decision: “Antibiotics do not make viral infections resolve faster and can cause side effects.”
- Offer an alternative plan: provide guidance on rest, hydration and symptom relief appropriate to the patient’s specific condition.
- Set a follow-up point: state clearly when the patient should get back in touch or seek immediate medical attention.
If an antibiotic is prescribed, explain the treatment goal, how to take it, any medicines or foods to avoid when relevant, common side effects, signs of a serious allergic reaction and the principle of not sharing medication. The teach-back technique can be used: teach-back: ask the patient to explain, in their own words, how they will take the medicine and which signs mean they should get back in touch.
5. Measure and provide feedback for improvement
A clinic should begin with one or two measures that can be collected consistently, such as:
- The proportion of visits for uncomplicated acute bronchitis in which an antibiotic is prescribed.
- The proportion of patients with pharyngitis who receive testing when indicated before treatment.
- The proportion of prescriptions documenting the diagnosis, allergies, current medicines and treatment duration.
- The proportion of patients at risk of treatment failure who receive guidance or reassessment.
- The number of adverse reactions, return visits or referrals related to antibiotics.
Feedback should be used to improve the system, not to assign blame to individuals. Records can be reviewed monthly, challenging cases discussed, bottlenecks identified and materials updated. The CDC framework for outpatient antibiotic stewardship commonly emphasizes leadership commitment, accountability, pharmacy expertise, action, tracking, reporting and education; implementation should be scaled to each facility’s resources.
An 8-question checklist for patients
- What condition am I being diagnosed with? Is the condition likely to be caused by bacteria, or is it more likely viral?
- Is an antibiotic truly necessary? If I do not start it now, what is the follow-up plan?
- Do I need testing before a decision is made? When will the results be available, and who will explain them?
- Have I provided a complete medication history? Tell the clinician about allergies, prescription medicines, over-the-counter medicines, medicines for chronic conditions and dietary supplements.
- How should I take the medicine? Ask about the dose, timing, food, medicines to avoid and what to do if you miss a dose.
- Which signs are mild side effects, and which require emergency care?
- When should I get back in touch if I do not improve? Do not extend the course, switch medicines or use an old prescription without advice.
- Do I need a follow-up appointment or repeat testing? This depends on the specific condition; simply finishing the medicine does not mean that every situation is necessarily safe.
If you have been prescribed a medicine, follow the prescriber’s instructions and read the label carefully. If you suspect an allergic or serious reaction, do not switch to another medicine on your own; seek medical help.
Signs that require medical advice or emergency care
Contact a healthcare facility if symptoms worsen, do not improve by the time you were told to expect improvement, you cannot drink or keep fluids down, or you develop unusual symptoms after taking the medicine. Seek emergency care for difficulty breathing, swelling of the lips, tongue or throat, shock, confusion or reduced consciousness, bluish discoloration, chest pain, seizures or rapid deterioration.
Severe or persistent diarrhoea, bloody diarrhoea, a widespread rash, blistering skin or jaundice also require medical assessment. Urgency depends on age, pregnancy, underlying conditions, medicines already taken and the actual signs; young children, older adults and people with weakened immune systems often need to seek advice sooner.
Common mistakes and how to correct them
| Mistake | Why it is concerning | Practical correction |
|---|---|---|
| Prescribing an antibiotic solely because the sputum is yellow or green | The colour of secretions alone does not prove that a bacterial infection requiring antibiotics is present. | Assess the full course of illness, examination findings and warning signs. |
| Reusing an old prescription | The current illness may have a different cause, severity or interaction risk. | Arrange a reassessment or consult a healthcare professional before taking it. |
| Failing to record a reassessment point | Patients may increase the dose themselves, extend treatment or overlook treatment failure. | Record when the patient should get back in touch and which signs require urgent assessment. |
| Measuring prescription volume alone | Fewer prescriptions do not necessarily indicate better quality if patients who need treatment are missed. | Measure prescribing appropriateness, clinical outcomes, side effects and referrals as well. |
| Explaining the decision with difficult terminology | Patients may not understand why the medicine is not needed or how to monitor their condition. | Use short sentences and ask the patient to repeat the plan in their own words. |
A minimum implementation roadmap for clinics
- Assign responsibility: designate one person to coordinate outpatient antibiotic stewardship and a backup when needed.
- Choose the initial scope: Prioritize one or two common situations, such as the common cold or sore throat.
- Standardize the form: Add fields for the diagnosis, allergies, current medications, the reason for prescribing or not prescribing an antibiotic, follow-up instructions, and warning signs.
- Measure the baseline: Review a sample of medical records at fixed intervals to identify whether the bottleneck lies in diagnosis, testing, software, guidance, or communication.
- Provide feedback and adjust: Discuss the data with prescribers, update the materials, and measure again after each change.
- Check safety: Ensure that reducing antibiotic prescribing does not increase missed cases requiring treatment, complications, delayed referrals, or inappropriate return visits.
Small clinics do not necessarily need the infrastructure of larger systems, but they still need an accountable person, specific actions, a minimum data set, and ongoing education. Treatment criteria, dosages, and treatment durations must come from professional guidance appropriate to Vietnam; do not infer them from this checklist.
Conclusion: The right decision matters more than a prescription
Outpatient antibiotic stewardship is a quality-improvement process: identify the problem correctly, use tests appropriately, prescribe according to guidelines, communicate clearly, monitor outcomes, and improve through data. Patients should ask for a clear explanation of the diagnosis and follow-up plan, avoid buying or reusing antibiotics on their own, and seek help when severe symptoms occur.
Antimicrobial resistance is not a reason to delay necessary treatment. It is a reason to ensure that every decision to use an antibiotic is evidence-based, explained clearly, and reassessed.
Reference source
- Core Elements of Outpatient Antibiotic Stewardship— Centers for Disease Control and Prevention.
- Outpatient Clinical Care for Adults— Centers for Disease Control and Prevention.
- Healthy Habits: Antibiotic Do’s and Don’ts— Centers for Disease Control and Prevention.
- Strengthening primary health care to address antimicrobial resistance— World Health Organization, ngày 23 tháng 4 năm 2025.
- Strengthening primary health care-oriented health systems to address antimicrobial resistance— World Health Organization, 2025.
