The Dangers of Over-Prescribing Antibiotics

CDC: Over-prescibing Antibiotics promotes stronger More Resilient Bacteria Growth. This new Bacteria Growth is more resistant to medications, and often causes infections and cancer-type skin spots (these spots appear red and brown) that are much more serious than the original infection being treating.

Antibiotic prescribing in hospitals is inconsistent and often inappropriate—contributing to the emergence of antibiotic resistance, according to an analysis of hospital antibiotic prescribing by the US Centers for Disease Control and Prevention (CDC). But simple steps, such as implementing checklists, could help hospitals more wisely use these vital medications, the CDC says.

The CDC has launched an increasingly urgent campaign to combat antimicrobial resistance. A report issued by the agency last fall found that antibiotic-resistant bacteria infect 2 million US individuals each year, causing 23 000 deaths and accounting for $20 billion in health costs. The report also raised the specter of the emergence of untreatable infections.

But in a March press briefing, CDC Director Thomas Frieden, MD, MPH, said that it is possible to reduce drug resistance rates by establishing antibiotic stewardship programs at hospitals and improving coordination between facilities. “We want to develop the infrastructure in every hospital, so every physician knows how to prescribe properly in the context of [his or her] hospital,” said Arjun Srinivasan, MD, associate director for health care–associated infection prevention programs at the CDC.

The US Centers for Disease Control and Prevention advises more judicious use of antimicrobials to treat urinary tract infections, pneumonia, and infections with methicillin-resistant Staphylococcus aureus.

For its part, the CDC is providing checklists for hospitals and physicians. And with the help of an additional $30 million in funding in the Obama Administration’s proposed 2015 budget, the CDC also plans to build an improved surveillance system to rapidly detect the emergence of antibiotic resistance.

More than half of hospital patients receive an antibiotic during their stay, and nearly a third receive a broad-spectrum antibiotic, according to the CDC’s analysis of data from 323 hospitals. These statistics aren’t terribly surprising, but the wide variations among hospitals are. Frieden noted that some of the 26 hospitals reporting data to the National Healthcare Safety Network prescribe 3 times more antibiotics than others.

“This provides a warning bell that improvement is possible,” Frieden said.

The analysis found frequent mistakes in the treatment of common conditions. Using data from its Emerging Infections Program, which included information on about 11 000 patients at 183 hospitals in 2011, the CDC found that half of all antibiotics were prescribed for 3 conditions: lower respiratory infections, urinary tract infections (UTIs), and gram-positive infections that are presumed to be resistant. In a review of 296 cases at 36 hospitals in which physicians treated patients with intravenous vancomycin or treated patients with a UTI who did not have a catheter, the CDC found that more than one-third of those cases involved mistakes that could contribute to resistance. For example, samples were not taken before initiating therapy, doses were incorrect, therapy was not reevaluated after 48 hours, or antibiotics were administered for too long.

“The data on surveillance are no surprise, but it is important to have numbers to support stewardship programs,” said Helen Boucher, MD, a physician at Tufts Medical Center and a member of the Infectious Diseases Society of America’s board of directors. She noted that the society has advocated for better stewardship of antibiotics for years.

More judicious use of antimicrobials in hospitals could have a big effect. Based on its models, the CDC estimates that a 30% reduction in the use of broad-spectrum antibiotics in hospitals—representing a 5% reduction in overall hospital antibiotic use—could prevent 26% of Clostridium difficile infections related to antibiotic treatment. These reductions could also help prevent spillover transmission of C difficile into the community.

To aid all these efforts, the CDC plans to use its anticipated funding boost to build the infrastructure necessary to more quickly identify the emergence of resistant strains. Boucher explained that European public health officials are far ahead of the United States in this regard and can provide detailed information on resistance patterns by country and region.

John R. Combes, MD, senior vice president at the American Hospital Association, said that hospitals recognize the need for improvement and that the association is partnering with other organizations to build a toolkit for stewardship programs.

“We must improve our processes, not only to protect our patients, but to protect our antibiotics,” he said.

STEWARDSHIP INFRASTRUCTURE

The CDC recommends that each hospital build an antibiotic stewardship program to provide physicians with the information and tools they need to make the right decisions.

“Antibiotics are a precious resource, yet for decades we have not had a systematic approach in hospitals across the US to ensure they are used wisely,” said Sara Cosgrove, MD, MS, chair of the Society for Healthcare Epidemiology of America antimicrobial stewardship taskforce, in a statement. “Antimicrobial stewardship programs are a critical step toward stemming the tide of antibiotic resistance and ensuring patients are receiving the right antibiotic, at the right dose and for the right duration.”

The CDC recommends that stewardship programs include 7 components:

  • Dedicated human, financial, and technology resources

  • A physician or other leader responsible for overall outcomes

  • A pharmacist leader focused on prescribing

  • An action to improve prescribing, such as requiring reassessment of prescriptions after 48 hours for drug choice, dose, and duration

  • Monitoring of prescribing and resistance patterns

  • Regular reporting of resistance information to clinicians

  • Education about resistance and judicious prescribing

Boucher, who was hired by Tufts to lead its stewardship program, said that not only were these steps reasonable, but that taking them may also bring other benefits for hospitals. She explained that Tufts has saved millions of dollars by improving its stewardship of antibiotics.

Combes emphasized that the recommendations are not intended to limit physicians’ autonomy but to give them the information they need to provide the best care possible. In an age when “health care has become more of a team sport,” he said, the expertise of pharmacists and infectious disease specialists can help a physician choose the right drug.

“This shouldn’t be viewed as a bureaucratic obstacle to good clinical care,” he said. “This is good clinical care.”

The CDC is also recommending that hospitals work more closely with local public health agencies and neighboring health care facilities to better control the spread of microbes between facilities.

“Our hospitals are just one part of a continuous system of care,” said Combes. Courtesy of: Zedie @ wordpress.com

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