Challenges, Success Factors, and Directions for the Future
Although guidelines exist for diagnosis and treatment of common infections, diagnostic uncertainty remains a challenge. Health care providers are frequently influenced by psychosocial factors which drive prescribing decisions, including concerns for both patient satisfaction with a clinical visit and potential negative consequences because of missed diagnoses. Providers are also concerned about losing dissatisfied patients to other providers who might be more likely to prescribe antibiotics. Patients who are aware of the potential risks for antibiotic overuse might still express a preference for antibiotic treatment because of perceived benefits. Antibiotic stewardship interventions and educational efforts aimed at addressing both diagnostic uncertainty and patient expectations will remain important.
Interventions to improve antibiotic prescribing have proven effective in the short-term and within specific settings. It remains less clear which interventions are sustainable and scalable. For this reason, strong stakeholder partnerships and buy-in at the personal, clinic, and health care system levels are fundamental to improving antibiotic prescribing. CDC is working with federal partners, including the Centers for Medicare and Medicaid Services, the U.S. Food and Drug Administration, and the Veterans Health Administration to improve prescribing. CDC partnerships with nonfederal stakeholders, such as vendors of antibiotic prescribing data, state health departments, and professional medical societies are also important.
In March 2015, The National Action Plan for Combating Antibiotic-Resistant Bacteria was released, outlining key actions to combat antibiotic resistance in the United States (https://www.whitehouse.gov). These actions include preventing the development and spread of resistant infections, increasing surveillance efforts, developing new drugs and diagnostic tests, and promoting international collaboration to prevent and control antibiotic resistance. In the United States, changes in health care delivery and increased implementation of quality measures provide opportunities to integrate antibiotic stewardship practices. Tracking antibiotic prescribing, regardless of clinical setting, is important in identifying opportunities to improve prescribing and maintain provider accountability. Priority should be placed on reducing prescribing for diagnoses for which inappropriate antibiotic prescribing is common (e.g., acute bronchitis) and on U.S. regions with higher antibiotic prescription rates. Reducing inappropriate antibiotic use and addressing the threat of antibiotic resistance is critical to improve health care quality and to safeguard patient safety across all health care settings.
This is another in a series of occasional MMWR reports titled CDC Grand Rounds. These reports are based on grand rounds presentations at CDC on high-profile issues in public health science, practice, and policy. Information about CDC Grand Rounds is available at https://www.cdc.gov/cdcgrandrounds.
Morbidity and Mortality Weekly Report. 2015;64(32):871-873. © 2015 Centers for Disease Control and Prevention (CDC)