Antimicrobial Stewardship Flashcards
What is antibiotic stewardship?
Primary goal is to optimize clinical outcomes while
minimizing unintended consequences of
antimicrobial use, including toxicity
What part of pharmacy has been the traditional focus of antibiotic stewardship?
Focus has been on institutions; a large number of
antibiotics are prescribed in the outpatient setting (this is harder to manage due to less direct institutional control)
Why is stewardship needed?
30% of all antibiotic prescriptions and 50% of all prescriptions for
respiratory infections are inappropriate
In Canada, 1 in 4 primary care antibiotic prescriptions were written for conditions where antibiotics are rarely or ever indicated ( viral)
How does resistance to antibiotics in microorganisms increase?
Inappropriate use drives resistance
When a patient ingests an antibiotic, susceptible
organisms are killed or inhibited while resistant
organisms remain and can thrive (this occurs during appropriate and inappropriate use of antibiotics, but we don’t get intended benefit with inappropriate use)
What are the benefits of antimicrobial stewardship?
Improved patient outcomes
Reduced adverse events including C. difficile infection
Improvement in rates of antibiotic susceptibilities to targeted antibiotics
Optimization of resource utilization
What are the consequences of antimicrobial misuse and subsequent resistance?
More severe illness; longer recovery time
May require hospitalization or prolong hospitalization.
More HCP visits
Need to use more toxic antibiotics
More deaths
What percentage of infection in Canada show resistance to antibiotics?
Almost 25% of all infections
Which professionals are involved in controlling antibiotic resistance?
Core:
Infectious disease physicians
Clinical pharmacists with infectious disease training
Good additions:
Clinical microbiologist
Information system specialist
Infection control professional (often nurses)
Hospital epidemiologist
How is antibiotic stewardship practiced in hospitals?
Preauthorization
Prospective audit and feedback
Clinical practice guidelines (facility specific) with dissemination and implementation strategy
Computerized clinical support (presents warnings and disclaimers to prescribers)
Target specific patient groups or drugs
What is a pharmacist’s role in antibiotic stewardship?
Patient education
Educate self about local infection
Assessing appropriateness of drug therapy
Know the indication and assess dose accordingly
Preventing infections in the first place (mask, vaccines)
Promote safe sex practices
What are some principles pharmacists should follow to improve antibiotic stewardship?
Use the best drug- if a drug is needed:
First step is always to determine if an antibiotic is needed
Narrow spectrum rather than broad spectrum
Prevent infection:
If an infection doesn’t develop, no need to prescribe antibiotics
VACCINATION
Hand hygiene/ cough and sneeze etiquette
Safer sex
Select shortest effective duration
Correctly assessing antibiotic allergies:
Many ‘allergies’ are intolerances and not true allergies`
Allergies due to cross-
reactivity to side chains and not the beta-lactam ring structure (other drugs in the class can still be used)
What are some strategies that could improve antibiotic stewardship?
Watchful waiting or delayed
prescribing
Non-antimicrobial
recommendations
Physician feedback on prescribing
Improved communication between the patient and
HCP
Showing commitment to stewardship
Education
HCP and consumers
