CPhT CONNECT™ Magazine - Jan/Feb 2021


Broad Interventions: As the title implies, these interventions involve obtaining prior authorization to prescribe certain antibiotics. Also, they require performing audits on patient treatment protocols involving antibiot- ics and re-evaluating the use of antibiotics while a diagnosis is still ongoing. The initial antibiotic pre- scribed in an emergent situation may not always be the best choice once lab work or other diagnostic work has been completed. Pharmacy-Driven Interventions: Interventions at the pharmacy level include adjust- ing doses of antibiotics and maintaining a high level of awareness as related to duplicate therapies and drug interactions. Pharmacy-level interven- tions can also include helping patients transition from more intensive intravenous antibiotic treat- ments to oral options. Infection/Syndrome Specific Interventions: Infection-specific interventions are designed to provide clear direction to prescribers on using anti- biotics to treat infections with a history of antibiotic overuse. This category includes community-ac- quired infections (those acquired in a hospital or long-term care setting) such as pneumonia, skin and tissue infections, MRSA, C. diff, chronic uri - nary tract infections, and blood infections. If all three of these interventions are appropriately implemented at the hospital or long-term care levels, it is believed that medical settings will see their antibiotic data improve. Core Elements of Antibiotic Stewardship Programs: The Centers for Disease Control and Prevention have identified several specific elements that must be adequately and continually addressed for stewardship programs to be successful. They include: • Leadership Commitment: Involves dedicating essential financial, technology, and human resources to the stewardship process. • Accountability: It is most beneficial to appoint a single point contact person who is responsi- ble for program outcomes. Similar programs have shown that a physician leader is often the most effective. • Drug Expertise: Similar to accountability, appointing a single pharmacist leader respon- sible for improving antibiotic prescription and use is important. • Action: The process of implementing at least one recommended action as defined by the Centers for Disease Control and Prevention. • Tracking: The process of monitoring antibiotic prescribing and resistance patterns. • Reporting: Continuing to regularly report information on antibiotic use and resistance to doctors, nursing staff, and other relevant medical staff. • Education: To ensure the ongoing success of antibiotic stewardship programs, education is


essential. Education should focus on educating clinicians and relevant medical personnel about antibiotic resistance and the best pre- scribing practices. For antibiotic stewardship programs to remain successful, all critical groups within a medical community must work together. Programs must involve contributions and participation from cli- nicians and department heads, epidemiologists, infection preventionists, quality improvement staff, laboratory staff, information technology staff, and nursing staff. Antibiotic stewardship programs across the nation continue to evolve. In 2018, the Centers for Disease Control and Prevention provided data indicating approximately 85% of hospitals across the country had implemented (or were close to implementing) some form of an antibiotic stewardship program. Consequently, the strategies for improving antibiotic use and best practices for ongoing improvements to antibiotic stewardship continue to evolve and improve as well. Utilizing IT to monitor clinical data and leverage decision-making regarding prescriptions and data management only further benefits an antibiotic stewardship program. As more hospitals and clini- cal care settings (including long-term care facilities) begin to or continue to embark on antibiotic stew- ardship programs, more data regarding antibiotic resistance and ways to limit how antibiotic resis- tance impacts communities will also be collected. For decades, overprescribing or misusing antibiotics has led to highly resistant microbes and bacteria. Implementing robust antibiotic stewardship pro- grams can help to reduce instances of antibiotic misuse and begin to reduce cases of failed antibi- otic treatments due to growing antibiotic resistance. If you work in or are a member of the medi- cal community and are curious about antibiotic stewardship programs in your hospital or commu- nity, reach out to your facility’s program leaders. Antibiotic stewardship programs are not new to the medical community; however, many profes- sionals remain unfamiliar with these programs in medical communities and the community at large.

Antibiotic stewardship is a nationwide effort to measure and improve the means through which antibiotics are prescribed by members of the medical community and used by patients. Improving how antibiotics are prescribed and used is essential to ensuring infections are appro- priately treated. Furthermore, patients must be protected from undue harm caused by unnec- essary or inappropriate antibiotic use and antibiotic resistance. While the Centers for Disease Control and Prevention and other members of the medical community recognize that there is no one-size-fits-all approach to medical deci - sion-making surrounding antibiotic use, it helps to understand the core elements and goals of these programs to improve overall patient health.

Why Antibiotic Stewardship Programs Are Important: Since their discovery, antibiotics have evolved the practice of medicine. Using anti- biotics has made once lethal infections treatable and enhanced the possibility of other life-saving medical interventions such as chemotherapy and organ transplants. While using antibiotics reduces morbidity statistics and saves lives, there are ongo- ing concerns and dangers pertaining to antibiotic overuse and overprescribing. It is estimated that as many as 30% of antibiotics prescribed in acute care settings across the nation are likely unnecessary. Antibiotics (like all medications) can have serious side effects, even when used safely. These effects occur in as many as 20% of patients who receive them in a hospital setting. These patients are then placed at increased risk for adverse health effects as well as eventual antibiotic resistance. Also, patients who do not use antibiotics can experience adverse health effects due to antibiotic misuse through the increased spread of antibiotic-resistant organisms. Proper implementation of antibiotic stewardship measures can help increase cure rates while reduc- ing treatment failures, antibiotic-resistant infections (such as C. difficile), adverse medication effects, antibiotic resistance, and hospital treatment costs. Three Types of Antibiotic Stewardship Interventions: In the publication “The Core Elements of Hospital Antibiotic Stewardship Programs,” the Centers for Disease Control and Prevention outlined three main types of stewardships that can improve the use and impact of antibiotics on patients and the com- munity. These stewardships include broad interventions, pharmacy-drive interventions, and infection/syndrome-specific interventions.

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