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Let’s Take an Antibiotic Time Out

Categories: Antibiotic use, Clostridium difficile, Gram negatives, Healthcare-associated infections

Arjun Srinivasan MD

Author – Arjun Srinivasan, MD
CDC – Medical Director, Get Smart for Healthcare Program

Over the past 2 years, I have brought together experts on antibiotic resistance to discuss how CDC can assist in efforts to improve antibiotic use in hospitals and nursing homes. My colleagues have published numerous studies demonstrating that inappropriate antibiotic use in hospitals and nursing homes results in increased resistance, worse patient outcomes, and increased costs.  It is also helping drive the national epidemic of Clostridium difficile infections.  This year, we have watched as deadly new mechanisms of antibiotic resistance were discovered in U.S. hospitals, mechanisms that will undoubtedly challenge our healthcare system and affect patient safety (see NDM-1, VIM). Clearly, we have a serious problem.

Those initial discussions with colleagues resulted in an expansion of CDC’s Get Smart programs, which target antibiotic use in outpatient clinics and pediatrician’s offices, to include a comprehensive program targeting inpatient settings.  This week, CDC launched the Get Smart for Healthcare program aimed reducing inappropriate antibiotic use in hospitals and nursing homes.  The foundation of this program is the concept that everyone plays a role in improving antibiotic use.

Healthcare providers – following 3 simple steps will ensure you are prescribing antibiotics wisely and help promote efforts to optimize use. First, all orders must contain a dose, duration, and an indication. Secondly, when placing orders, make certain that they include laboratory cultures. And finally, when your culture results come back in 24-48 hours, take an antibiotic time-out – reassess therapy. With this additional information, ask yourself – Is this antibiotic still warranted or, more importantly, is this antibiotic still effective against this organism? (See Dr. Srinivasan on Medscape.)

Healthcare administrators and payers — Interventions to improve antibiotic use can be done in any setting. Every facility – regardless of setting and hospital size – should emphasize and implement antibiotic stewardship. Administrators play a key role in supporting these efforts and helping send the message that optimal antibiotic use is an important patient safety issue. Antibiotic stewardship helps improve patient care and shorten hospital stays, thus benefiting patients as well as the hospitals. It is a “win‐win” for all involved, especially as payments are increasingly tied to quality.

Patient and caregivers – Ask questions. Ask your healthcare provider – Why do I need this antibiotic? What will this antibiotic treat? How long will I have to be on this antibiotic? What are the side effects?

Antibiotics are a shared resource; for some infections, they are a scarce resource.  The solution cannot be to solely focus on developing new drugs.  New antibiotics are a long way off and even when we have them, they might not be the panaceas we are hoping for.  But most importantly, if we don’t act now to improve the way we use antibiotics, we will quickly lose any new drugs we’re lucky enough to get.  It’s time for us all to act to improve antibiotic use.

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  1. December 9, 2010 at 11:00 pm ET  -   DR.RATNA RAO

    Hi
    Hi,
    I agree with Dr.Srinivasan we need to take an antibiotic time out .I come from a tertiary care hospital and have been seeing the with rising trend of PDR bugs. Its time we health care providers sit back and think a moment before we prescribe.

    Link to this comment

  2. November 24, 2010 at 4:56 pm ET  -   Teresa Price

    Hello,
    my professor asked me to come and put in some of my findings after reading my essay from one of my assignments in her class. I decided that I would just let you read my essay. All the things that are in my essay are from my personal experiences. I am the one that is allergic to penicillin and having 4 children and one of them having chronic infections thats where I learned the items in my essay. I hope it helps. Thank you.

    “When the Antibiotics Quit Working”

    Having four children and being around someone that has chronic conditions like constant sinus infections, I have seen firsthand when antibiotics have stopped working. So, building immunity to antibiotics is more common than many think. There are things that help when antibiotics no longer work, like keeping areas clean, washing your hands, cleaning door handles with disinfectant, and caring antibacterial lotions and gels, building an immune system that helps fight off common illnesses is another way of not having to take an antibiotic.
    When one antibiotic stops working, doctors often switch to another antibiotic. There are instances where the doctor will up the doses or strength of the antibiotic. In some cases people can be allergic to the antibiotic like penicillin. This can keep the person from taking any form of the strain of that medication. This limits the person to antibiotics when there’s an important need for the medication.
    Building a strong immune system can help in cases like common colds. Taking vitamins like vitamin C can help in building that strong immune system. Getting plenty of sun and fresh air can also help. Exercising and eating healthy can also help in building a strong immune system.
    Keeping your home clean is a good way of keeping germs at bay. Sweeping up dirt, dusting, moping and cleaning areas like counters and the bathroom area with disinfectant help keep infectious germs away. Washing dishes in hot water and not cold is also a healthy way of killing some germs in the house hold, also wiping down the phone and doorknobs periodically with disinfectant helps with the spread of germs particularly the common cold. More colds are spread by the telephone receiver and doorknobs than anything else in the home.
    When colds are caught it is best to start taking care of it early so that seeing a physician doesn’t become necessary. There are plenty good over the counter medications that work very well on common colds. A pharmacist can assist in suggesting those medications. There are new over the counter medications put out just for the cure of the common cold, like “Cold Ease,” and they work quite well on some if taken as directed and when the cold comes on. If your immune system is strong enough even some flues can be cured with over the counter medications. Getting a flu shot can also be beneficial to most.
    Although scientist are working towards stronger and better antibiotics like everything, germs and diseases are evolving, we will lose the ability to use antibiotics against those germs and diseases if we don’t take our own measures to help with the situation. Try to not to take antibiotics for the minor illnesses and take them when only nothing else works. Being healthier and being more aware with the environment is a good start. Dress according to the weather, keeping clean and keeping your home clean will also help. Teaching children the proper way of coughing and sneezing so they don’t spread germs, and making sure they know that they should wash their hands after eating, coughing and sneezing, and using the restroom. Doing all these things will help with building an immunity to the minor diseases and we can reserve the antibiotics for when it is really needed.

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  3. November 17, 2010 at 5:10 pm ET  -   L McClure

    Antibiotics seem to be “dished” out like M & Ms. Gone are the days when the physician would wait for your body to fight off infection. Those poor white blood cells have lost their job of fighting infection, antibiotics have taken over!

    Link to this comment

  4. November 17, 2010 at 2:40 pm ET  -   Jon A. Green, M.D.

    The CDC needs to extend its efforts towards a greater eduction of the public to the coming crises, and to stop the use of antibiotics in animal feed. The widespread use of fluoroquinolones in chicken feed in the USA is considered to be the source of E. coli resistant to this antibiotic class. Doxycycline is one of a limited number of antibiotics capable of safely treating human MRSA. Nevertheless tetracyclines are used in animal feed in Denmark where there have been reports of doxycycline resistant staph.

    The CDC has a fiduciary responsibility to alert the public to the real threat of antibiotic resistance. This is a public health issue that has yet to reach the level of public awareness that it deserves.

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  5. November 17, 2010 at 12:16 pm ET  -   A Johnson

    Antibiotic used for the proper health problem I think its fine .But a to much is no good .As far as Seniors in Nursing Homes and Hospital Dr.they should be monitored very closely

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