Wednesday, November 15, 2017

Be Antibiotics Aware: Smart Use, Best Care

It’s Antibiotic Awareness Week — Nov. 13-19

Jane D. Siegel, MD
Pediatician/Pediatric Infectious Diseases Specialist
Chair, Texas Medical Association Committee on Infectious Diseases

Editor's Note: November 13-19 is Antibiotic Awareness Week. The following post offers recommendations to limit exposure to antibiotics to only those people who truly need them, in order to avoid development of bacterial infections for which there will be no effective therapy. 

No physician wants to see a patient with a serious infection for which we have no antibiotic to treat it effectively. That is why this week, the Centers for Disease Control and Prevention (CDC) is asking us — physicians and patients — to rededicate ourselves to improving the use of antibiotics. 

For physicians, this means limiting prescriptions for antibiotics to conditions likely to benefit patients, thereby reducing the risk of the emergence of antibiotic-resistant bacteria. If we overuse antibiotics, we run that risk, as treatments for infections from these bacteria stop working because the antibiotics no longer kill the bacteria.

The Texas Medical Association is collaborating with the Texas Department of State Health Services on activities to improve antimicrobial use. Antibiotic Awareness Week, which coincides with similar efforts in Europe, Australia, and Canada, and by the World Health Organization, reminds us to think about how we use antibiotics.
Here are two activities physicians can initiate or emphasize this week, incorporate into our practices, and explain to patients and their families:

1. Antibiotic time out: Right drug, right bug, right duration                                                          
This practice of fine-tuning of physicians’ decision-making involves a few straightforward steps to ensure we use antibiotics only when needed according to established recommendations. 

CDC has some excellent graphics and information for patients and their families so they understand how physicians make treatment decisions and why they might not prescribe an antibiotic in a given situation. This practice is applicable to long-term care facilities (LTCFs) and is a component of the antimicrobial stewardship program that the Centers for Medicare & Medicaid Services will require in all LTCFs in coming years. 

Patients: These are the rules your physician applies to prevent antibiotic overuse when they care for an ill patient:
  • Does this patient have a bacterial infection that requires antibiotics? If the physician believes a patient’s illness could be caused by a bacterial infection, he or she will run appropriate diagnostic tests and prescribe a drug that will be effective against the organisms likely to cause the infection.  The physician might write a prescription for three days with a refill to complete the medication course. If the physician and patient cannot determine whether the patient has a penicillin allergy, the physician may recommend testing the patient to know if drugs containing penicillin are safe to use. Alternatively, the physician may watch and wait without antibiotics and reevaluate later.                      
  • Reevaluate at 48-72 hours. The physician then assesses how the patient is feeling. If any diagnostic test results identify the cause of the infection, the physician may prescribe a more narrow-spectrum antibiotic (a drug that treats only a specific family of bacteria). This helps prevent antibiotic resistance by targeting only the specific bacterium in play and would be effective for the remainder of the patient’s treatment for this illness. If there is more evidence to support a viral infection, the physician will discontinue antibiotic treatment, as antibiotics do not treat viral infections.
  • The physician will determine the necessary duration of the antibiotic course, based on evidence-based clinical pathways, which are clinical guidelines physicians can follow to treat various clinical conditions. Such guidelines are developed by reviews of carefully conducted studies and are endorsed by professional societies. 
2. Buy meat and poultry products that come from animals NOT fed antibiotics as growth factors.   
      The practice of using antibiotics as growth-promoting elements is an important risk factor for antimicrobial resistance. Antibiotics used this way encourage emergence of resistant bacteria in the animals. These resistant bacteria reside on the surface of meat or poultry products and are passed on to humans inadvertently if not handled safely.
Farmers and veterinarians have been educated to stop this practice, and we are making progress in the United States. But there is more work to do. When you go to the supermarket, buy only meat or poultry that says specifically, “No antibiotics used.” Designations such as “organic” or “no growth hormone” do NOT mean the meat or poultry is free of antibiotics. If you do not see this type of packaging in your market, ask the store to start carrying products from antibiotic-free animals. The more demand for these products, the more supply we will find. Both patients and physicians can heed this advice. Visit the CDC website for more information on antibiotic-resistant solutions, food safety challenges, and a U.S. Food and Drug Administration question and answer page

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