Antibiotic stewardship, or the effort to reduce the misuse of antibiotics to prevent drug resistance, needs to focus on specific decisions based on evidence-based clinical best practices. New guidelines from the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) offer detailed strategies to reap the best outcomes from antibiotic stewardship programs and keep drug-resistant microbes at bay.
The new guidelines, published this week in the journal Clinical Infectious Diseases, will replace earlier versions of stewardship guidelines and will add specific, hands-on strategies health centers can implement to reduce risk in their own care environments.
The recommendations include closer monitoring and/or preauthorization of medications that are designed to attack emerging drug-resistant microbes, hoping to reserve these drugs as “special forces” instead of common, front-line treatments. The guidelines also call for faster results on lab testing for respiratory samples, speeding up the “is it bacterial or viral?” question and providing earlier guidance for what sorts of treatments physicians may prescribe to combat the infection.
The difficult challenge of Clostridium difficile (C. diff) receives specific discussion in the guidelines, where recommendations now urge physicians to reduce the use of antibiotics and provide “antibiotic time-outs” when dealing with infections that have a high risk of resulting in a C. diff infection (CDI). “The goal of reducing CDI is a high priority for all [antibiotic stewardship programs] and should be taken into consideration when crafting stewardship interventions,” the guidelines state.
The guidelines suggest using the GRADE method (Grading of Recommendations Assessment, Development and Evaluation) to help clinicians decide what treatment course to take. The step-by-step evaluation weighs the possible benefits and harms caused by the administration of each antibiotic based on clinical evidence, while taking into account the availability and cost of the treatment and the resident’s wishes.
Antibiotic stewardship strategies should also focus on optimization of drug treatment outcomes, the guidelines add. Such strategies include alternating dosing strategies, cycling/mixing the antibiotics used, switching from IV to oral forms of antibiotics whenever possible and taking advantage of computerized clinical decision support systems.
“Initially, antibiotic stewardship was more focused on cost savings, and physicians responded negatively to that, because they often felt it was best to give patients the newest, most expensive drug,” said Tamar Barlam, MD, co-author of the guidelines and director of the antibiotic stewardship program at Boston Medical Center, in an IDSA announcement. “While these programs do save money, their most important benefit is that they improve patient outcomes and reduce the emergence of antibiotic resistance. When we say stewardship, we really mean stewardship, and increasingly, doctors are realizing it’s important and necessary.”
An estimated 23,000 people die annually from antibiotic-resistant infections, according to the Centers for Disease Control and Prevention. The federal government has urged the adoption of antibiotic stewardship programs at all levels of healthcare to reduce the risks of developing germs that are resistant to antibiotics and will be tougher to kill later on.
The antibiotic stewardship program guidelines are available for free here.