{"id":10512,"date":"2020-04-27T09:00:23","date_gmt":"2020-04-27T13:00:23","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=10512"},"modified":"2021-04-16T15:08:52","modified_gmt":"2021-04-16T19:08:52","slug":"antibiotic-stewardship","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/antibiotic-stewardship\/","title":{"rendered":"What is antibiotic stewardship? How you can practice it"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">You\u2019ve got a bad cough, stuffy nose, and sore throat. You visit your healthcare provider and ask for antibiotics. Your primary care provider declines to give you a prescription and explains that you have a virus. Meaning, the best treatment is rest, fluids, and some OTC meds. What gives? This is an example of good antibiotic stewardship.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If what you have is truly viral, then<\/span> <a href=\"https:\/\/www.singlecare.com\/blog\/how-do-antibiotics-work\/\"><span style=\"font-weight: 400;\">antibiotics won\u2019t work<\/span><\/a><span style=\"font-weight: 400;\">\u2014they\u2019re only for bacterial infections. You might leave your healthcare provider&#8217;s office frustrated that you\u2019re stuck with a prescription to sleep and hydrate instead of one for<\/span> <a href=\"https:\/\/www.singlecare.com\/prescription\/amoxicillin\"><span style=\"font-weight: 400;\">amoxicillin<\/span><\/a><span style=\"font-weight: 400;\">. But, by trusting your clinician\u2019s judgment, you\u2019re practicing good antibiotic stewardship, too.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">It\u2019s important because the inappropriate use of antibiotics can lead to a host of problems for healthcare providers and patients alike. Here\u2019s the scoop on what antibiotic stewardship means and all the ways you can play a role in promoting it.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">What does antibiotic stewardship mean?<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Antibiotic stewardship, sometimes also referred to as antimicrobial stewardship, is a joint effort by healthcare providers to embrace responsible prescribing of antibiotics. That includes prescribing antibiotics only when they are needed (i.e., for bacterial infections, not viral ones), prescribing the appropriate antibiotics for the diagnosed infection, and prescribing the right dose and <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/finish-antibiotics\/\"><span style=\"font-weight: 400;\">duration of antibiotic treatment<\/span><\/a><span style=\"font-weight: 400;\">, among other things.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">According to the Centers for Disease Control and Prevention (CDC), focusing on the<\/span> <a href=\"https:\/\/www.cdc.gov\/antibiotic-use\/core-elements\/\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">responsible use of antibiotics<\/span><\/a><span style=\"font-weight: 400;\">:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Improves treatment of bacterial infections<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Protects patients from unnecessary side effects<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Limits the kind of overuse that leads to antibiotic resistant bacteria or \u201c<\/span><a href=\"https:\/\/newsinhealth.nih.gov\/2014\/02\/stop-spread-superbugs\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">superbugs<\/span><\/a><span style=\"font-weight: 400;\">\u201d<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">\u201cPrescribing doctors mean well\u2014they want to fix people, and the short-term downside for most antibiotics is small since they are generally safe and inexpensive,\u201d explains <a href=\"https:\/\/www.houstonmethodist.org\/\">Houston Methodist<\/a> infectious disease expert Richard Harris, MD.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The problem, says Dr. Harris, comes when most of the patients you are trying to \u201cfix\u201d don\u2019t actually need the treatment you\u2019re providing: \u201cYou want to make sure you\u2019re not missing something, but you end up overtreating 50 [patients] for every one patient who actually needs to be treated.\u201d<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">When did antibiotic stewardship start?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Because there is too much inpatient and outpatient use of antibiotics overall, stewardship programs have developed across the country to mitigate the widespread unnecessary prescribing of these drugs. It\u2019s unclear exactly when these programs worked their way into nearly every major hospital and healthcare facility in the United States, but Dr. Harris says the initiative was long overdue (as of 2018, nearly<\/span> <a href=\"https:\/\/www.cdc.gov\/antibiotic-use\/community\/images\/materials\/2018-Core-Elements-Percentages.jpg\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">85% of hospitals nationwide<\/span><\/a><span style=\"font-weight: 400;\"> were meeting CDC guidelines).<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The Society for Healthcare Epidemiology of America (<\/span><a href=\"https:\/\/www.shea-online.org\/index.php\/practice-resources\/priority-topics\/antimicrobial-stewardship\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">SHEA<\/span><\/a><span style=\"font-weight: 400;\">) is another organization that promotes antimicrobial stewardship programs, providing tools and resources to healthcare professionals for implementation in acute care hospitals and long-term care facilities across the country. By improving the use of antimicrobials, SHEA states that these programs enhance patient outcomes, reduce antimicrobial resistance, and decrease healthcare-associated infections among other quality improvements.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Kathryn A. Boling, MD, a primary care provider with <a href=\"https:\/\/mdmercy.com\/\">Mercy Medical Center<\/a> in Baltimore, agrees, calling the shift in focus onto antibiotic use a gradual change in response to the rise in resistant organisms, an increasing need to use powerful, intravenous antibiotics instead of common oral ones, and other environmental factors.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cPeople are flushing their antibiotics down the toilet or urinating out small amounts of these drugs, and it\u2019s contaminating the water we drink,\u201d she says. \u201c[All those things together] were enough to make the medical community say \u2018uh-oh.\u2019\u201d<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In 2014, the CDC began rolling out specific guidelines and recommendations for how healthcare facilities, from hospitals to outpatient offices, could educate physicians and patients on the appropriate use of antibiotics through stewardship programs.\u00a0<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">3 types of antibiotic stewardship interventions<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">In <\/span><a href=\"https:\/\/www.cdc.gov\/antibiotic-use\/healthcare\/pdfs\/core-elements.pdf\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">The Core Elements of Hospital Antibiotic Stewardship Programs<\/span><\/a><span style=\"font-weight: 400;\">, the CDC laid out three main types of stewardship interventions that can improve the use of antibiotics: broad interventions, pharmacy-driven interventions, and specific interventions for infections and syndromes.<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\"><b>Broad interventions<\/b><span style=\"font-weight: 400;\"> involve getting prior authorization to prescribe certain antibiotics, performing audits on cases involving antibiotics, and re-evaluating the antibiotics prescribed while diagnostic information is being collected. For example, you\u2019re given ciprofloxacin in the emergency room for a suspected kidney infection while your blood work is sent to the lab; once your results come back, the prescribing physician revisits your info to see if that\u2019s still the best antibiotic for you.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Pharmacy-driven interventions<\/b><span style=\"font-weight: 400;\"> include adjusting doses of antibiotics, looking out for duplicate therapies and drug interactions, and assisting with transitions from IV to oral antibiotics.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Infection\/syndrome specific interventions<\/b><span style=\"font-weight: 400;\"> offer clear instructions for prescribers on using antibiotics to treat many infections with a history of antibiotic overuse, including: community-acquired pneumonia, urinary tract infections, skin and soft tissue infections,<\/span> <a href=\"https:\/\/www.cdc.gov\/mrsa\/community\/index.html\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">MRSA infections<\/span><\/a><span style=\"font-weight: 400;\">, Clostridium difficile infections (C. diff), and bloodstream infections that have been proven by culture.<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">If all three of these interventions are implemented, it follows that a hospital will see its antibiotic use data improve. But these interventions aren\u2019t achieved by simply waving a magic wand. Hospitals have to invest in creating a solid antibiotic stewardship program based on several core elements outlined by the CDC. These elements work a little differently in other healthcare settings, but generally remain the same whether the stewardship program is taking place at inpatient or outpatient facilities.<\/span><\/p>\n<table class=\" singlecare-table\">\n<tbody>\n<tr class=\"header-row\">\n<td><b>Element<\/b><\/td>\n<td><b>Hospital<\/b><\/td>\n<td><b>Nursing Home<\/b><\/td>\n<td><b>Outpatient Setting<\/b><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">Leadership<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Commit to providing human, financial, and technical resources<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Commit to improving antibiotic use and\u00a0 communicating that commitment with staff, residents, and families<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Appoint single leader and\/or include stewardship in job descriptions<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">Accountability<\/span><\/td>\n<td><span style=\"font-weight: 400;\">One physician leader appointed<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Engage medical director, nursing director, and other key staff in supporting efforts<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Communicate widely with patients about efforts via flyers and face-to-face conversations<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">Drug expertise<\/span><\/td>\n<td><span style=\"font-weight: 400;\">One pharmacist leader appointed<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Consult and partner with community experts in infectious disease<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Provide clinicians with opportunities to consult with experts on or off-site<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">Action<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Implement at least one intervention that can be regularly evaluated<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Develop action plans to implement one or more of the three interventions<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Use evidence-based prescribing, watchful waiting, and off-site triage for viral infections<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">Tracking<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Keep track of prescribing and resistance patterns<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Track antibiotic use and outcome measures<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Self-evaluate and adopt at least one tracking\/reporting system<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">Reporting<\/span><\/td>\n<td><span style=\"font-weight: 400;\">All relevant staff are informed of progress<\/span><\/td>\n<td><span style=\"font-weight: 400;\">none<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Self-evaluate and adopt at least one tracking\/reporting system<\/span><\/td>\n<\/tr>\n<tr>\n<td><span style=\"font-weight: 400;\">Education<\/span><\/td>\n<td><span style=\"font-weight: 400;\">All relevant staff are trained on responsible prescribing<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Use flyers, guides, emails, and workshops to educate all staff, residents and families<\/span><\/td>\n<td><span style=\"font-weight: 400;\">Educate patients with materials and in-person conversations; provide continuing education opportunities for physicians<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2><span style=\"font-weight: 400;\">Why it\u2019s important<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The benefits of antibiotic stewardship programs, beyond the obvious reduction in the overuse of these drugs, apply to both individuals and the community at large, says Dr. Boling.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">For individual patients, misusing antibiotics may mean you:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Have a harder time getting rid of the infection if it returns<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Become sick with an antibiotic-resistant infection that can\u2019t easily be treated<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">End up with mild to severe antibiotic side effects, ranging from nausea and diarrhea to <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/yeast-infection-from-antibiotics\/\"><span style=\"font-weight: 400;\">yeast infections<\/span><\/a><span style=\"font-weight: 400;\">, anaphylaxis, kidney failure, or<\/span><a href=\"https:\/\/www.singlecare.com\/blog\/antibiotics-that-cause-c-diff\/\"> <span style=\"font-weight: 400;\">infection with C. diff<\/span><\/a><span style=\"font-weight: 400;\"> (a bacteria that causes persistent diarrhea and colon inflammation)<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">On a broader, public health level, incorrectly prescribing antibiotics:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Increases antibiotic resistance and C. difficile infections overall<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Raises healthcare costs<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Lowers patient safety outcomes<\/span><\/li>\n<li style=\"font-weight: 400;\"><span style=\"font-weight: 400;\">Leaves everyone vulnerable to those nasty superbugs<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">The more hospitals and outpatient care settings that adopt antibiotic stewardship programs, the more impact the collective efforts will have. The only tricky thing is evaluating the effectiveness of these programs. Drs. Boling and Harris both say that as of right now, there isn\u2019t an official way to see if efforts are working. If a hospital can report a reduction in antibiotic use\u2014or a reduction in adverse events as a result of using antibiotics\u2014that\u2019s considered a win.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Dr. Boling adds that physicians practicing good antibiotic stewardship can also self-evaluate: \u201cAs an individual physician, you can look at your own personal metric. I can usually tell [the difference between a viral and bacterial infection] with my exam, but if I have a patient insisting something more is going on, I order a chest X-ray to confirm. Very rarely does that patient actually need antibiotics.\u201d<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">How patients and providers can work together<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If you\u2019re wondering how you can do your part to limit antibiotic prescribing, it\u2019s easier than you may think.<\/span><span style=\"font-weight: 400;\">\u00a0<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400;\"><b>Don\u2019t make an appointment for every little thing.<\/b><span style=\"font-weight: 400;\"> \u201cPatients can stop asking for antibiotics the minute they get the sniffles,\u201d says Dr. Boling. \u201cIf you don\u2019t have a fever or the illness hasn&#8217;t been going on for 10 days or more, the chances are low you need antibiotics.\u201d<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Don\u2019t call your healthcare provider\u2019s office and ask staff to call in a prescription without an exam. <\/b><span style=\"font-weight: 400;\">Many illnesses associated with antibiotic overuse, like urinary tract infections, should be diagnosed with a culture before a prescription is written.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Trust your primary care provider.<\/b><span style=\"font-weight: 400;\"> Dr. Harris says that if more people relied on their doctor\u2019s judgment, resisting the urge to be disappointed when their doctor says their illness is only viral, doctors would feel less pressured to treat their patients unnecessarily with antibiotics.<\/span><\/li>\n<li style=\"font-weight: 400;\"><b>Stay up to date on your vaccinations.<\/b><span style=\"font-weight: 400;\"> \u201cIn my years of practice, the most beneficial thing that helps patients with infectious disease is vaccines,\u201d says Dr. Harris. The fewer viral infections you get, the less likely you\u2019ll be to seek out antibiotics when you\u2019re not feeling well, lowering your chances of receiving a prescription you don\u2019t really need.<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">One more thing: Every November, the World Health Organization (WHO) celebrates Antibiotic Awareness Week, encouraging all healthcare facilities, providers, and the general public to increase their education about the power of antibiotics\u2014and how, if that power isn\u2019t wielded correctly, it can lead to widespread consequences.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In 2020, Antibiotic Awareness Week will be celebrated from Nov. 11 to 17. Visit the WHO<\/span> <a href=\"https:\/\/www.who.int\/news-room\/campaigns\/world-antibiotic-awareness-week\/world-antibiotic-awareness-week-2019\/landing\" target=\"_blank\" rel=\"noopener noreferrer\"><span style=\"font-weight: 400;\">website<\/span><\/a><span style=\"font-weight: 400;\"> to learn more about how you can practice it in your home, doctor\u2019s office, hospital, or community.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>You\u2019ve got a bad cough, stuffy nose, and sore throat. You visit your healthcare provider and ask for antibiotics. Your primary care provider declines to give you a prescription and explains that you have a virus. Meaning, the best treatment is rest, fluids, and some OTC meds. What gives? This is an example of good [&hellip;]<\/p>\n","protected":false},"author":93,"featured_media":10191,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[4589],"tags":[715,729,788],"coauthors":[8860],"class_list":["post-10512","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-drug-info","tag-antibiotics","tag-doctor-visits","tag-drug-safety","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>What is antibiotic stewardship? How you can practice it<\/title>\n<meta name=\"description\" content=\"Antibiotic stewardship (also called antimicrobial stewardship) means only taking these prescriptions when you really need them. 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