Background: The outpatient setting is a key scenario  for the implementation of antimicrobial stewardship (AMS) activities,  considering that overconsumption of antibiotics occurs mainly outside  hospitals. This publication is the result of a joint initiative by the  JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks, which is aimed at  formulating a set of target actions for linking surveillance data with  AMS activities in the outpatient setting.

Methods: A  scoping review of the literature was carried out in three research  areas: AMS leadership and accountability; antimicrobial usage and AMS;  antimicrobial resistance and AMS. Consensus on the actions was reached  through a RAND-modified Delphi process involving over 40 experts in  infectious diseases, clinical microbiology, AMS, veterinary medicine or  public health, from 18 low-, middle- and high-income countries.

Results: Evidence  was retrieved from 38 documents, and an initial 25 target actions were  proposed, differentiating between essential or desirable targets  according to clinical relevance, feasibility and applicability to  settings and resources. In the first consultation round, preliminary  agreement was reached for all targets. Further to a second review, 6  statements were re-considered and 3 were deleted, leading to a final  list of 22 target actions in the form of a practical checklist.

Conclusions: This  White Paper is a pragmatic and flexible tool to guide the development  of calibrated surveillance-based AMS interventions specific to the  outpatient setting, which is characterized by substantial inter- and  intra-country variability in the organization of healthcare structures,  maintaining a global perspective and taking into account the feasibility  of the target actions in low-resource settings.