COMMENTARY

Antibiotic Prescribing in Hospitals: Improvements Needed

Tom Frieden, MD, MPH

Disclosures

March 04, 2014

Editorial Collaboration

Medscape &

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The recent CDC Vital Signs report[1] shows that antibiotic prescriptions in hospitals are often written incorrectly.

About half of hospital patients receive an antibiotic during the course of their stay. But doctors in some hospitals prescribe 3 times more antibiotics than doctors in other hospitals, even though patients were receiving care in similar areas of each hospital.

About one third of antibiotics prescribed in hospitals for urinary tract infections included a potential error -- the antibiotics were given for too long, without proper evaluation, or weren't necessary at all. Similarly, about 1 in 3 prescriptions for the drug vancomycin were also written with a potential error. There is a lot of room for improvement.

Antibiotic stewardship programs optimize treatment and make sure that patients receive antibiotics promptly and only when needed. They make sure that patients receive the right antibiotic at the right dose and for the right length of time, improving prescribing in hospitals and long-term care facilities, saving money, and saving lives.

So that patients receive the safest care possible, CDC recommends that every hospital adopt an antibiotic stewardship program with 7 basic elements:

1. Leadership commitment. Dedicate the necessary human, financial, and IT resources.

2. Accountability. Appoint a single leader responsible for program outcomes. Physicians have proven successful in this role.

3. Drug expertise. Appoint a single pharmacist leader to support improved prescribing.

4. Action. Take at least 1 action to improve prescribing. For example, implement a universal reassessment within 48 hours to double-check drug choice, dose, and duration.

5. Track. Monitor antibiotic prescribing and resistance patterns.

6. Report. Regularly report to staff on antibiotic prescribing and resistance information and what can be done to improve.

7. Educate. Offer education about antibiotic resistance and best prescribing practice.

We have to preserve the antibiotics that we have now -- and those that we develop in the future -- by implementing effective strategies to improve antibiotic prescribing. Together, we can protect patients today and protect lifesaving antibiotics for the future.

Web Resources

Fridkin S, Baggs J, Fagan R, et al. Vital Signs: Improving antibiotic use among hospitalized patients. MMWR. 2014; 63; 1-7.

Press Release: Poor Antibiotic Prescribing Putting Hospital Patients at Risk for Deadly Infections

Digital Press Kit: Antibiotic Prescribing Putting Patients at Risk

Centers for Disease Control and Prevention: Core Elements of Hospital Antibiotic Stewardship Programs

Centers for Disease Control and Prevention: Checklist for Core Elements of Hospital Antibiotic Stewardship Programs

Centers for Disease Control and Prevention: State-Based HAI Prevention. Success Stories -- HAI Prevention Stories From the States

Centers for Disease Control and Prevention: Get Smart for Healthcare

Centers for Disease Control and Prevention: Healthcare-Associated Infections - Clostridium difficile Infection

Centers for Disease Control and Prevention: Antibiotic/Antimicrobial Resistance Threat Report 2013

Centers for Disease Control and Prevention: Antibiotic/Antimicrobial Resistance

Frieden T. Will the Medicine Cabinet Be Empty When You or Your Child Need Life-Saving Antibiotics? (Slideshow) Huffpost Healthy Living. February 26, 2014.

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