CDC Urges Doctors to Improve Antibiotic Prescribing

March 04, 2014

In a push to reduce antibiotic resistance and deadly Clostridium difficile infections, the Centers for Disease Control and Prevention (CDC) today urged physicians to improve their prescribing habits in hospitals.

A CDC study released today showed where there was room for improvement. It found that clinicians at some hospitals ordered 3 times as many antibiotics as their peers at other institutions even though ward settings were similar. In addition, study authors spotted potential errors in about 1 in 3 prescriptions for vancomycin as well as antibiotic prescriptions in particular for urinary tract infections. The potential errors included lack of diagnostic cultures and keeping patients on antibiotics for too long.

The good news in the study, published in the CDC's latest Morbidity and Mortality Weekly Report, was the ability of some hospitals in the study to sharply reduce C difficile diarrheal infections. A 30% reduction in the use of antibiotics that typically trigger these infections — fluoroquinolones and extended-spectrum cephalosporins are 2 examples — lowered their incidence by more than 25%.

However, nobody should mistake the study as a call for physicians simply to prescribe fewer antibiotics, or refrain from prescribing them immediately for a suspected infection, said CDC Director Tom Frieden, MD, MPH, at a press briefing today.

"We're not saying don't start patients on an antibiotic," said Dr. Frieden. "We're saying use antibiotics wisely."

Dr. Frieden reminded clinicians to follow 3 basic protocols:

  • Start antibiotics for a presumed infection promptly, but order recommended cultures beforehand.

  • Be sure to specify the drug's indication, dose, and expected duration in the patient's chart.

  • Reassess the situation within 48 hours based on test results and a patient examination. If need be, adjust the drug's dosage and duration, switch to a new drug, or end antibiotic therapy.

In addition to wise prescribing, physicians can also help halt the spread of C difficile and drug-resistant bacteria by spearheading hospital-wide antibiotic stewardship programs. "Physicians have proven successful in this role," said Dr. Frieden. Assigning a single leader to take responsibility for outcomes is one item on a 7-point checklist for stewardship programs that the CDC is recommending.

"It's Not Too Late. We Can Reverse Drug Resistance"

During the press briefing, Dr. Frieden noted that the White House's proposed budget for fiscal year 2015, released today, will invest an additional $30 million in CDC efforts to combat antibiotic resistance. Assuming Congressional approval, the agency would use this extra cash to help hospitals implement antibiotic-resistance stewardship programs, and "improve the rapid detection of antimicrobial threats," said Dr. Frieden. In 5 years' time, the nation could see infection rates for both C difficile and carbapenem-resistant Enterobacteriaceae decline by half as a result of this investment.

"It's not too late," said Dr. Frieden. "We can reverse drug resistance."

The proposal to spend more on the war against antibiotic resistance garnered praise from the Infectious Diseases Society of America (IDSA).

"On behalf of the millions of patients who suffer from resistant infections, IDSA has long called for increased federal leadership to address this public health crisis," the IDSA said in a news release. "This budget request is an important step forward, and we urge Congress to fully fund it."

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