The Infectious Diseases Society of America has published evidence-based practice guidelines for evaluating antimicrobial stewardship programs and emphasizes the importance of physician and pharmacist leadership as well as infectious disease expertise. The need for antimicrobial stewardship programs has been recognized in the National Action Plan for Combating Antibiotic-Resistant Bacteria by the White House in March 2015, which calls for establishing antimicrobial stewardship programs in all acute care hospitals by 2020.
The structure of these programs is addressed in the CDC’s Core Elements of Hospital Antibiotic Stewardship Programs (See: Key Elements to Hospital Antimicrobial Stewardship Programs).3 Unfortunately, about a quarter to a half of all antibiotics prescribed in U.S. acute care hospitals are believed to be unnecessary or inappropriate.3
Automatic changes from intravenous (IV) to oral antibiotic therapy when appropriate can improve patient safety. Fluoroquinolones, trimethoprim-sulfamethoxazole, and linezolid are some examples of antibiotics with good oral absorption. Renal dose adjustments for antibiotics are also important in patients with renal dysfunction. Other pharmacy interventions may include dose optimization, assessment for duplication of therapy, automatic stop orders, and prevention of antibiotic-related drug-drug interactions.
Antibiotic “time outs” are important since antibiotics are often initiated empirically while cultures are being obtained. After 48 hours, the treatment should be reviewed to determine if the antibiotic selected was appropriate and whether the dosage and duration of therapy are correct.3
Information technology staff can facilitate antimicrobial stewardship programs by incorporating drug information guidelines at the point of care, implementing clinical decision support tools for antibiotic use, and creating prompts for clinicians to review antibiotics. It is also critical to monitor antibiotic prescribing and report clinical interventions and outcomes to improve antibiotic use. Providing education that includes antibiotic drug information, patterns of antimicrobial resistance, and case studies can also play an integral role in the success of antimicrobial stewardship programs.
Resources for Pharmacists
Timothy Gauthier, PharmD, BCPS-AQ ID, is an antimicrobial stewardship and infectious diseases pharmacist practicing in Miami, FL who created the IDstewardship website, which provides pharmacists and other healthcare professionals with up-to-date information about antimicrobial resistance and antimicrobial stewardship programs. The content is written by experts in the area and is divided into three main free open-access sections. The resource center is geared toward those interested in antimicrobial stewardship programs and provides links to open-access institutional antimicrobial stewardship program websites, clinical practice resources, important guidelines, educational opportunities, learning activities for children, and much more.
“As someone obsessed with the topic, I frequently update this page with the latest and greatest stewardship resources (many of which these days are found via social media),” says Gauthier. The website includes articles written by experts about a variety of hot topics including residency and training, pharmacy news, and practical advice for pharmacists and students. The basic study guide is another resource with important talking points on various antimicrobial agents along with drug photos and links to relevant articles. There is also a section called IDstewardship Training at LearnAntibiotics.com.
Gauthier’s development of this digital resource was based on a perceived need in the pharmacy community. “It all started with Instagram, which I started using professionally in early 2014 after watching a show on PBS’s Frontline called “Generation Like.” This episode showed me that social media is the future, and I thought if we can combine this with pharmacy education and scholarship.
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