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Selected Category: Antibiotic use

The Power of Antibiotic Stewardship in Patient Care

Categories: Antibiotic use, Healthcare-associated infections

Don Goldmann, MD

Don Goldmann, MD

Author: Don Goldmann, MD
Chief Medical and Scientific Officer
Institute for Healthcare Improvement
Clinical Professor of Pediatrics
Harvard Medical School
Professor of Immunology and Infectious Diseases, and Epidemiology
Harvard School of Public Health

For the past several years, IHI has been actively engaged in working with a wide variety of acute care hospitals in partnership with the Centers for Disease Control and Prevention (CDC) and other national experts to advance antibiotic stewardship. Our overarching goal is to reduce adverse drug events related to inappropriate antibiotic utilization, the prevalence of antibiotic resistance, the risk of Clostridium difficile infection, and the cost of care.

We developed a framework for reducing inappropriate antibiotic utilization and a set of key practical change concepts and related metrics that caregivers could implement as part of their routine work at the bedside. These recommendations were designed to support hospitals across the US (regardless of size, acuity, or geographic location) in their efforts to curb unwarranted antibiotic utilization. A key learning from initial testing of the framework in a group of pilot hospitals emphasized the power of stewardship when relatively simple practices are incorporated into the everyday work of hospitalists and care teams, preferably in collaboration with pharmacists.

IHI’s upcoming Expedition on Antibiotic Stewardship will spread what we learned in this initial testing to help other hospitals create a more reliable system for sound antibiotic prescribing. The Expedition is designed to support hospitals where they are currently — whether they are just starting to implement stewardship or are hoping to accelerate improvement in their existing programs. Specific interventions that have been particularly successful will be highlighted, including:

  • An “antibiotic time out” — a pause at 48 to 72 hours to review the indication and expected duration of antimicrobial therapy, and make appropriate adjustments or discontinue treatment based on available clinical data; and
  • Use of multidisciplinary rounds to engage all team members in antibiotic stewardship goals, opportunities for improvement, and action.

IHI’s Expedition can help identify and begin improving key processes to optimize antibiotic selection, dose, and duration in their patient care setting and share additional strategies for effectively incorporating antibiotic stewardship into existing patient care processes.

Sometimes the Safest Prescription is “Wait and See”

Categories: Antibiotic use, Antimicrobial Resistance

Adam L. Hersh, MD, PhD

Adam L. Hersh, MD, PhD

Guest Author – Adam L. Hersh, MD, PhD
Assistant Professor of Pediatrics
Division of Pediatric Infectious Diseases
University of Utah

Get Smart About Antibiotics Week is a great opportunity to call attention to a priority that we all share: preserving the effectiveness of antibiotics for the future. Doctors and other practitioners on the front-lines of ambulatory care may become frustrated when they hear the way they practice medicine is partly to blame for the urgent threat of antibiotic resistance.

For those of us working in ambulatory care settings, it is a really busy and demanding job, and for many patients with upper respiratory tract infections (URIs), it’s hard to know who has a bacterial infection and who doesn’t. This year, Get Smart About Antibiotics Week is featuring the publication of Principles of Judicious Antibiotic Prescribing for Pediatric Upper Respiratory Tract Infections in the journal Pediatrics. It discusses the importance of diagnostic certainty and reviews the clinical criteria practitioners should use when determining the likelihood of a bacterial infection.

There are established and stringent clinical criteria that should be applied to justify an antibiotic prescription for the key URIs in pediatrics that are potentially caused by bacteria. Many bacterial URIs will resolve on their own without antibiotic treatment. And the serious and justifiably feared complications of URIs (such as mastoiditis as a complication of otitis media) usually cannot be prevented by early antibiotic therapy anyway. All of this is important to consider as our understanding continues to grow about the harms antibiotics can cause.

Antibiotic overuse not only contributes to increased resistance but also avoidable adverse drug events including serious allergic reactions, cardiovascular problems and chronic conditions such as eczema, asthma, inflammatory bowel disease and obesity. Doctors want to do what is safe and in their patients’ best interests. When there is a considerable degree of uncertainty regarding the diagnosis for patients with URIs, sometimes the safest thing to do is to “wait and see.”

Preserving Antibiotic Effectiveness: Everybody’s Responsibility

Categories: Antibiotic use, Antimicrobial Resistance

Ramanan Laxminarayan, PhD.

Ramanan Laxminarayan, PhD

Guest Author – Ramanan Laxminarayan, PhD
Director, Center for Disease Dynamics, Economics & Policy

To many, antibiotic resistance may seem like an evergreen issue that reappears in the news cycle periodically. However, recent reports of the emergence and spread of carbapenem-resistant Enterobacteriaceae, described in CDC’s March 2013 Vital Signs Report remind us that we stand at the threshold of the post-antibiotics era and that we have a responsibility to bring broader attention to this serious public health threat.

In November of last year, a group of 26 organizations came together to sign the Joint Statement on Antibiotic Resistance, an agreement that put forth bold principles for protecting our current supply of working antibiotics while urging the development of new ones. Among the goals listed is the need for continued efforts to educate a wider audience about the looming danger of running out of effective antibiotics.

Last week, Extending the Cure released an animated video that explains in clear and engaging terms how antibiotic resistance emerges, what it costs to society, and why antibiotics must be conserved as a communal resource, like water and trees.

When Antibiotics Lead to Deadly Diarrhea…

Categories: Antibiotic use, Long Term Care (LTC)

Matthew Wayne MD, CMD

Matthew Wayne MD, CMD

Author – Matthew Wayne MD, CMD,
Chief Medical Officer for CommuniCare Family of Companies,
President of the American Medical Directors Association (AMDA)

So, you’ve recently taken antibiotics and you’ve now developed a case of disturbing diarrhea. Should you be concerned? Maybe so…
Antibiotic-associated diarrhea refers to diarrhea that develops in a person who is taking or recently took antibiotics. One of the most serious causes of antibiotic-associated diarrhea is Clostridium difficile (C. difficile) infection – a major cause of acute diarrhea in long-term care facilities. Not only does C. difficile cause discomfort, it actually results in nearly 14,000 deaths every year—90% of these involve people aged 65 or older. People who have recently taken antibiotics are at greatest risk for C. difficile, which is yet another reason we need to use these medications carefully in our nursing homes and long-term care facilities.

Addressing Antibiotic Use in Nursing Homes – It Starts with a Conversation

Categories: Antibiotic use, Long Term Care (LTC)

Nimalie Stone, MD

Nimalie Stone, MD

Author – Nimalie Stone MD,
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention.

As you have read in the posts from our academic and clinical partners, much work needs to be done to impact the systems and behaviors driving antibiotic use in the nursing home setting.

We believe many of the principles of antibiotic stewardship we apply in hospitals would also hold true in other healthcare settings. However, we do not have the same levels of clinical experience and research evidence to implement this activity in our nation’s nursing homes. As an important first step in developing a strategy to promote improved antibiotic use in these healthcare facilities, CDC has reached out to key partners across the nursing home industry to get their input and advice. In fact, today CDC is having face-to-face conversations with these industry stakeholders to discuss and outline next steps towards improved antibiotic use in nursing homes.

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