The indiscriminate use of antibiotics has created lethal complications for over 50,000 US citizens every year and 2 million people become infected with antibiotic resistant bacteria yearly. Clostridium Difficile superinfection alone affects 453,000 with over 29,000 deaths yearly and is predominantly related to antibiotic use which suppresses normal gut bacteria. Recent publications highlight the scope of the problem, goals for reduction and methods to achieve the results. Fleming-Dutra studied the inappropriate use of outpatient antibiotics and identified at least a 30% misuse rate. The accompanying editorial in JAMA surmised the study under reported problems and estimated the rate at closer to 50%. Imagine if patients realized that half the times they left with a prescription for an antibiotic they were putting themselves at risk for unnecessary harm, and even death.
The problem extends to hospitals , nursing homes and manifest in countless specific clinical scenarios including, sinusitis, upper respiratory infections, otitis media and pharyngitis. One particularly over treated condition is asymptomatic bacteriuria which is highly prevalent in the elderly and leads to unnecessary antibiotic use.
The White House announced in March 2015 a Plan to Combat Antibiotic Resistant Bacteria with the stated goal of reducing outpatient antibiotic use by 50% by 2020. Specific initiatives to achieve the goal are included in the report. Changing clinician behavior to alleviate concerns related to diagnostic uncertainty, alienating patients, and not conforming to peer practices is needed. Educating patients and families about the role of antibiotics in medical care can help engage the patient in their care. Simple validated interventions can be employed immediately.
Displaying a poster in patient waiting rooms indicating a commitment to avoiding inappropriate antibiotic prescriptions for acute respiratory tract infections was associated with a 20% decrease in antibiotic prescribing. Merely requesting clinician-documented justifications for antibiotic indications and emails with peer antibiotic-prescribing comparisons can effectively reduce inappropriate prescribing for acute respiratory tract infections. A 1-hour onsite clinician education session followed by quarterly personalized audit and feedback to primary care practitioners decreased antibiotic use 13%. The development of rapid diagnostic tests that identify viral infections from bacterial infections are very useful. A comprehensive report for implementing antibiotic stewardship programs to address these issues was recently promulgated, http://goo.gl/7dJ41X . The report provides excellent recommendations which are prioritized and categorized by validity.
Once again we have an opportunity to save lives by practicing evidence based medicine and engaging patients in their own care. Practical effective solutions are present. Prescriptive mandates and didactic lectures are ineffective in creating sustained changes in human behavior. Awareness and commitment to change is just the start of our journey to better use of antibiotics and safer healthcare for all.