CDC: Try Drug Stewardship to Curb Antibiotic Overuse

Healthcare providers that adopt a leadership model of drug stewardship can reduce the inappropriate use of antibiotics in hospitals, says the CDC.

More than half of all hospital patients receive an antibiotic. These drugs are not only overprescribed in hospitals, but also poorly prescribed, which can put patients at risk.

A Centers for Disease Control report released in March shows that some clinicians prescribe antibiotics three times as much as clinicians in other hospitals, even when patients were receiving similar kinds of care.

"Today's antibiotics are miracle drugs," says Arjun Srinivasan, MD, medical epidemiologist and medical director of for the CDC's Get Smart program for Healthcare. But their misuse is liked to preventable allergic reactions, super-resistant infections, and C. Diff, which can be deadly.

Antibiotic overprescription is not a new problem. Clinicians have long felt pressured to prescribe antibiotics inappropriately. Sometimes, they feel they don't have time to view test results or even perform testing prior to prescribing. Other times they feel pressured by patients to "do something."

Checklists Can Help
Checklists are an important tool toward ensuring that all clinicians know when antibiotic medications should be prescribed. The CDC's checklists highlight the core elements of the stewardship programs, Srinivasan says. While much of the information is basic, such as checking test results to ensure the patient actually has a bacterial infection—these are vital, commonsense steps that are frequently overlooked in the rush to treat many patients over the course of a day.

"We've already reached the point at which it's become critical to take preventative action," says Srnivasan. "We have infections that we've run out of antibiotics to treat. But we already have the knowledge [to prevent the worsening of the situation] at our fingertips. It's the perfect combination to take action to try and solve the problem."

Leadership is Vital
While there is no one solution to this problem, the CDC strongly suggests hospitals adopt drug stewardship programs to combat inappropriate use of antibiotics.

"This concept has been around for quite a long time. We used to call it drug management," says Srinivasan, "But stewardship is a much more accurate term. We're not trying to control or dictate—we're trying to manage a precious resource."

While there's no single model of stewardship, he suggests hospitals adopt programs that best fit their unique needs. One model that has worked in many settings is a physician leader running the program working closely with a pharmacist. A full stewardship checklist is here. At minimum, the CDC recommends these elements:

1. Leadership commitment: Dedicate necessary human, financial, and IT resources.
2. Accountability: Appoint a single leader responsible for program outcomes. Physicians have proven successful in this role.
3. Drug expertise: Appoint a single pharmacist leader to support improved prescribing.
4. Action: Take at least one prescribing improvement action, such as requiring reassessment within 48 hours to check drug choice, dose, and duration.
5. Tracking: Monitor prescribing and antibiotic resistance patterns.
6. Reporting: Regularly report to staff prescribing and resistance patterns, and steps to improve.
7. Education: Offer education about antibiotic resistance and improving prescribing practices.

Ideally, both the physician and the pharmacist would have some background in infectious diseases, although that's not always the case—some hospitals are very small and don't have infectious disease specialists on staff. "It doesn't have to be infectious disease physician," said Srinivasan. "Others have stepped forward—but this is what we recommend."

What's most important, said Srinivasan, is that leadership is established. "Leadership is vital. There must be a designated leader and pharmacist."

Pledges Reduce Inappropriate Antibiotic Prescribing Rates

Another important and much overlooked step is improved communication with patients. Often, says Srinivasan, patients request information, but do so in a way that sounds like they're requesting an antibiotic.

"Many have said that even though they're asking for an antibiotic, what they really want is an explanation. They want to know what's going on, how long will it last, when will they feel better?" said Srinivasan.

Properly educating patients about their conditions and explaining that not every illness requires an antibiotic and why, as well as how to take any medications prescribed, are simple yet vitally important steps toward combatting antibiotic resistance.