COMMENTARY

Fight the Resistance: A Call to Action for Hospitalists

Eric E. Howell, MD

Disclosures

November 02, 2015

Editorial Collaboration

Medscape &

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It's time to change how we prescribe antibiotics in America's hospitals, and you can help today.

I'm Dr Eric Howell, senior physician advisor at the Society of Hospital Medicine, associate professor of medicine at Johns Hopkins University and chief of the Division of Hospital Medicine at Johns Hopkins Bayview. Research from the Centers for Disease Control and Prevention indicate that nearly 1 in 3 antibiotics might be inappropriately prescribed.

Antibiotics are one of the major classes of drugs tied to adverse events for hospitalized patients. Clostridium difficile (C diff) infections are just one of the major harms created by overprescribing antibiotics. One quarter of a million hospitalized patients are infected with C diff every year, and 14,000 die of this potentially lethal infection.

Although a significant threat in the hospital today, the larger threat is that patients will eventually stop responding to antibiotics in all settings, including the outpatient and postacute care settings. That's why prescribing antibiotics appropriately is so important.

It's likely that you already know that. In fact, most hospitalists—physicians, physicians, nurse practitioners, physician assistants, and others responsible for caring for hospitalized patients—are already very familiar with the potential adverse effects of antibiotics.

I have been there. It's hard to tell patients that you won't give them antibiotics, especially when they see it as an easy fix to their condition, and they have received antibiotics from their trusted doctor and others in the past.

That's why it's up to you to change the culture of antibiotic stewardship in the hospital and promote appropriate prescribing, which includes the right agent, at the right time, at the correct dose, for an appropriate duration.

Together, with your colleagues and patients, you can fight the resistance. "Fighting the resistance" means working together to encourage antibiotic stewardship in the hospital. There are three important things that every hospitalist should do to fight the resistance.

First, work with your team. Physicians, nurse practitioners, physician assistants, pharmacists, and infectious disease experts need to all work together to ensure that antibiotics are used appropriately. And consider the patient as part of your team by discussing why antibiotics may not be the best choice of treatment.

Second, pay attention to appropriate antibiotic choice and resistance patterns, and identify mechanisms to educate providers on overprescribing in your hospital.

Third, rethink your antibiotic treatment time course. Be sure to adhere to antibiotic treatment guidelines, track use, and set a stop date when you first prescribe them.

You can also take the lead in changing the culture of your hospital by displaying new downloadable "Fight the Resistance" posters from the Society of Hospital Medicine. By putting them up in your break rooms, hallways, or other high-profile locations, you will remind your colleagues about the dangers of antibiotic resistance and promote their effective use. You can download these posters today at fighttheresistance.org.

On behalf of the Society of Hospital Medicine and the hospitalized patients we serve, thank you for fighting the resistance!

Web Resources

Society of Hospital Medicine: Fight the Resistance

CDC Get Smart About Antibiotics Week

ZdoggMD: "Dawn of the Diff (C Diff Rap Zombie Anthem)"

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