Antimicrobial Stewardship in Urgent Care Settings: A Systematic Review of Prescribing, Clinical, and Microbiological Outcomes.

Emergency and urgent care settings are frequently the first point of antimicrobial prescribing, making them a key setting for antimicrobial stewardship. Despite growing recommendations for implementing antimicrobial stewardship programs (ASPs) in urgent care settings, evidence of their effectiveness and impact remains dispersed. This systematic review evaluated the impact of ASPs on antimicrobial prescribing, clinical and microbiological outcomes, and implementation in urgent care settings. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. MEDLINE (PubMed), EMBASE, Web of Science, and Scopus were searched from inception to identify eligible studies. Randomized and non-randomized studies, interrupted time series analyses, before-and-after studies, and cohort studies conducted in adult or pediatric urgent care settings were included. Two reviewers independently screened studies, extracted data, and assessed methodological quality. Owing to methodological and clinical heterogeneity, findings were synthesized narratively. Twelve studies published between January 2016 and March 2026 met the inclusion criteria. Most interventions combined clinician education, prescribing guidelines, clinical decision support, audits with feedback, pharmacist reviews, or multidisciplinary stewardship strategies. Eleven of the twelve completed studies reported reductions in antimicrobial prescribing or improved prescribing appropriateness following program implementation. Educational and guideline-based interventions demonstrated the largest reductions in broad-spectrum antibiotic use. Clinical outcomes, including mortality and return visits, remained largely unchanged. Evidence relating to microbiological and economic outcomes was limited, although Clostridioides difficile infection rates were generally stable or improved. ASPs improve the quality of antimicrobial prescribing in urgent care settings without adversely affecting patient outcomes. Greater standardization of stewardship interventions and outcome measures, together with robust multicenter studies evaluating microbiological and economic endpoints, is needed to strengthen the evidence supporting routine implementation in urgent care settings.