Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians

Lee, Rachael A; Centor, Robert M.; Humphrey, Linda L.; Jokela, Janet A.; Andrews, Rebecca; Qaseem, Amir

doi:10.7326/m20-7355

Cited by 67 publications

(44 citation statements)

References 31 publications

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“…It confirms unnecessarily long durations of antibiotic therapy for common bacterial infections, such as acute bronchitis with chronic obstructive pulmonary disease (COPD) exacerbation, community-acquired pneumonia, urinary tract infections (UTIs), and cellulitis, contribute to antimicrobial overuse and resistance. 20 Continual quality improvement initiatives and monitoring are imperative to the core principles of antimicrobial stewardship. The information from this evaluation was presented to local ED leadership and providers at our community hospital to emphasize the importance of minimizing antibiotic duration of therapy for common infections, noting the tip sheet "Antibiotic Prescribing Tips for Patients Discharged from the ED" we created and distributed among the ED providers (displayed as Table 5 for reference).…”

Section: Discussionmentioning

confidence: 99%

Appropriateness of Antibiotic Prescribing in Patients Discharged From a Community Hospital Emergency Department

Bauman¹,

Russell²,

Morelli³

2022

PatientSaf

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IMPORTANCE: Every year, thousands of emergency department (ED) visits result in patients being discharged with oral antibiotic prescriptions. Published studies that assess the appropriateness of these antibiotic regimens are limited. PURPOSE: The purpose of this study was to examine the appropriateness of antibiotic prescriptions written for patients discharged from a community hospital’s ED. ENDPOINTS: The primary objective was to determine the overall percent of appropriate antibiotic prescriptions for patients discharged from the ED. Secondary objectives included the following: identify reasons for inappropriateness categorized by antibiotic selection, dose, duration, and allergies; identify the most common antibiotics prescribed inappropriately as well as the most common disease states that led to inappropriate prescribing of antibiotics; and analyze prescribing trends based on provider type and time of day the prescription was written. STUDY DESIGN AND METHODS: Patients eligible for inclusion were adults age 18 and older who presented to the ED during four chosen weeks in 2019 and who were discharged with oral antibiotics. Extracted electronic health record data was reviewed to identify the discharge diagnosis for each patient that meets the inclusion criteria. Pertinent information gathered from the patients’ medical records along with a validated antimicrobial assessment tool were utilized to determine the level of appropriateness of the prescribed antibiotic regimens. RESULTS: A total of 76% of the prescribed antibiotics were appropriate, 16% were inappropriate, and the remaining 8% were not assessable. Duration was the most common reason for a regimen to not be optimal. The most frequently inappropriately prescribed antibiotics included cephalexin (but it is noted cephalexin was included in almost half of the antibiotic regimens in this study), clindamycin, and azithromycin. Infections that were most frequently treated inappropriately were skin and soft tissue infections, dental infections, and sinusitis. Overall, medical residents prescribed the highest percent of appropriate regimens, and the time of day that had the highest percent of appropriate prescriptions was third shift (11 p.m. to 7 a.m.). CONCLUSION AND RELEVANCE: Almost half of all the nonoptimal antibiotic regimens had an excessive duration. Targeted local education efforts and future clinical decision support can facilitate appropriate prescribing of discharge antibiotics from the ED, ultimately improving antimicrobial stewardship within the community.

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Section: Discussionmentioning

confidence: 99%

Appropriateness of Antibiotic Prescribing in Patients Discharged From a Community Hospital Emergency Department

Bauman¹,

Russell²,

Morelli³

2022

PatientSaf

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“…30 • Each year, more data emerge about the safety of shorter durations of therapy. 31 Antibiotic therapy for community-acquired pneumonia has evolved from 10-14 day courses to courses as short as 3 days. 32 Intra-abdominal infections can be treated for 4 days after source control.…”

Section: Antibiotic Stewardship Interventionsmentioning

confidence: 99%

The state of antibiotic stewardship programs in 2021: The perspective of an experienced steward

Barlam

2021

ASHE

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Recognition of antibiotic stewardship programs (ASPs) as essential components of quality health care has dramatically increased in the past decade. The value of ASPs has been further reinforced during the coronavirus disease 2019 (COVID-19) pandemic because these programs were instrumental in monitoring antibiotic use, assessing emerging COVID-19 therapies, and coordinating implementation of monoclonal antibody infusions and vaccinations. ASPs are now required across hospital settings as a condition of participation for the Centers for Medicare and Medicaid Services and for accreditation by The Joint Commission. In the 2019 National Healthcare Safety Network annual survey, almost 89% of hospitals met the Seven Core Elements for ASPs defined by the Centers for Disease Control and Prevention. More than 61% of programs were co-led by physicians and pharmacists, evidence of the leadership role of both groups. ASPs employ many strategies to improve prescribing. Core interventions of preauthorization for targeted antibiotics, prospective audit and feedback, and development of local treatment guidelines have been supplemented with numerous emerging strategies. Diagnostic stewardship, optimizing duration of therapy, promoting appropriate conversion from intravenous to oral therapy, monitoring at transitions of care and hospital discharge, implementing stewardship initiatives in the outpatient setting, and increasing use of telemedicine are approaches being adopted across hospital settings. As a core function for medical facilities, ASP leaders must ensure that antibiotic use and ASP interventions promote optimal and equitable care. The urgency of success becomes progressively greater as complex patterns of antibiotic resistance continue to emerge, exacerbated by unpredictable factors such as a worldwide pandemic.

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“…These findings have been so compelling that they now feature in practice guidelines not only for infectious diseases specialists but also internists. 30 This significant paradigm shift, driven by emerging scientific data, illustrates the ongoing need for ethical re-examination of antimicrobial stewardship best practices in the future.…”

Section: Scenario Three: the Runaway (Antimicrobial) Trolleymentioning

confidence: 99%

Antimicrobial ethicists: Making ethics explicit in antimicrobial stewardship

Yen

Cutrell

2021

ASHE

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Antimicrobial prescribing and the associated discipline of antimicrobial stewardship have inherent ethical and moral dimensions. We contend that the explicit, formal application of ethical principles and frameworks can strengthen and further justify the value of antimicrobial stewardship programs and their work. To illustrate the value of this process, we highlight 3 ethical scenarios that antimicrobial stewardship programs regularly encounter at the prescriber, institutional, and societal levels, and we analyze these scenarios using the Beauchamp and Childress biomedical ethics framework.

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Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians

Cited by 67 publications

References 31 publications

Appropriateness of Antibiotic Prescribing in Patients Discharged From a Community Hospital Emergency Department

Appropriateness of Antibiotic Prescribing in Patients Discharged From a Community Hospital Emergency Department

The state of antibiotic stewardship programs in 2021: The perspective of an experienced steward

Antimicrobial ethicists: Making ethics explicit in antimicrobial stewardship

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