Overuse of antibiotics has been a concern in recent years. The Centers for Disease Control and Prevention (CDC) says that in some hospitals, doctors are prescribing three as more antibiotics than in other institutions. The large discrepancy indicated that in many situations, the use of antibiotics can be reduced. The agency published a study online in Morbidity and Mortality Weekly Report showing that antibiotic prescribing can be improved by more than 30 percent.
“We saw enormous variability … in the rate of antibiotic prescribing,” said CDC Director Tom Frieden, MD to MedPage Today. “We estimate that even a modest reduction in unnecessary or inappropriate prescribing would have major benefits in terms of reducing the number of infections, super-infections, and cases of C. difficile,” said Frieden.
The CDC study looked at several different data sources to analyze the use of antibiotics in hospitals. In their analysis of data from the MarketScan Hospital Drug Database, 55.7 percent of discharged patients received antibiotics during their hospital stay. In 2011, 49.9 percent of treatment antibiotics were prescribed for either lower respiratory infections, urinary tract infections and presumed resistant Gram-positive infections, based on data from the CDC’s Emerging Infections Program.
The CDC report that for UTIs in patients without catheters and in those treated with intravenous vanomycin, there could have been a 37.2 percent improvement with antibiotic use. For instance, Frieden said, doctors should make sure that patients actually have a UTI and not just colonization. “Often you’ll have urine cultures with all sorts of bacteria in them [and] that doesn’t necessarily mean infection,” he said to MedPage Today.
Frieden said that a seven-point program of antibiotic stewardship should be implemented in all hospitals:
- Support for the program from top administrators, with human, financial, and information technology resources
- Accountability through a single physician lead
- Drug expertise through a single pharmacy lead
- Action to improve prescribing, including requiring prescriptions to be re-assessed within 48 hours to check drug choice, dose, and duration
- Education for clinicians
- Tracking local prescribing and resistance information
- Reporting such data directly to clinicians
The Society for Healthcare Epidemiology of America signed on to Frieden’s message and noted that there are risks when antibiotics are overused. Sara Cosgrove, MD, MS, associate professor of medicine and epidemiology at Johns Hopkins University and chair of SHEA’s Antimicrobial Stewardship Taskforce stated to journalists, “Antimicrobial stewardship programs can help clinicians make good choices about the antibiotics they prescribe for their hospitalized patients.”