Preauthorization of broad-spectrum antibiotics and prospective review
Preauthorization of broad-spectrum antibiotics and prospective review after two or three days of treatment should form the cornerstone of antibiotic stewardship programs to ensure the right drug is prescribed at the right time for the right diagnosis, according to recommendations included in the new guidelines
Improving patient outcomes
Antibiotic stewardship programs save hospitals money, but their most important benefit is that they improve patient outcomes and reduce the emergence of antibiotic resistance.
Prospective audit allows antibiotic stewards to engage the prescribing clinician after the antibiotic has been used, typically after two or three days, to optimize antibiotic treatments.
Computerized clinical decision support
Other recommendations include reducing the use of antibiotics associated with Clostridium difficile infection, implementing antibiotic time-outs, and other strategies to encourage prescribers to perform routine reviews using computerized clinical decision support if possible.
Providers need to get approval to use antibiotics before they are prescribed.
White House officials urge intervention.
The White House has called for hospitals and healthcare systems to implement antibiotic stewardship programs by 2020 to ensure appropriate use of these vital drugs and reduce resistance.
The guidelines recommend focused multifaceted interventions for the treatment of specific syndromes, rather than trying to improve treatment of all infections at once. For example, those leading a hospital’s antibiotic stewardship program might take a close look at management of pneumonia during winter, including making recommendations to shorten the amount of time people are treated and switching to an oral agent more quickly, and then measuring the results of those interventions. In the fall, the program might focus on another intervention, like that for urinary tract infections.
Rapid diagnostic testing
The guidelines note that rapid diagnostic testing of respiratory specimens can help determine if the cause is viral and therefore reduce the inappropriate use of antibiotics.
Passive educational tools
Lectures and brochures should be used to supplement strategies such as antibiotic preauthorization and prospective audit and feedback.
Antibiotic stewardship to benefit patients and healthcare systems
It is key that these programs tailor interventions based on local issues, resources and expertise. To ensure that, the guidelines recommend the programs be led by physicians and pharmacists and rely on the expertise of infectious diseases specialists.
Preauthorization of broad-spectrum antibiotics and prospective review after two or three days of treatment should form the cornerstone of antibiotic stewardship programs to ensure the right drug is prescribed at the right time for the right diagnosis. These are among the numerous recommendations included in new guidelines released by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) and published in the journal Clinical Infectious Diseases.
1. Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis J. 2016; doi:10.1093/cid/ciw118