CDC - Blogs - Safe Healthcare - Dr. Fishman’s Top 5: Appropriate Antibiotic Use

Dr. Fishman’s Top 5: Appropriate Antibiotic Use
June 8th, 2010 12:44 pm ET -


Neil Fishman, M.D.
— Neil Fishman, M.D.

Antimicrobial resistance is one of the most pressing problems and greatest challenges that we will confront during the coming decade. As bacteria and other micro-organisms are becoming more resistant to antimicrobials, our current therapeutic options are dwindling and research and development of new antibiotics is lagging. For the first time since the discovery and introduction of penicillin in the 1940s, we are dangerously close to a return to the pre-antibiotic era.

I believe that antimicrobial stewardship is the best way to improve antibiotic use. The goals of antimicrobial stewardship are to ensure the proper use of antibiotics in order to reduce or stabilize resistance, to optimize clinical outcomes, and to decrease the risk of adverse events. SHEA and IDSA published Guidelines for Antimicrobial Stewardship Programs in 2007, but there are many simple steps practices and hospitals can take to improve antibiotic use without a complex infrastructure. For example:

•Never treat viral syndromes such as acute bronchitis with antibiotics, even when patients demand therapy.
•Use fluoroquinolones cautiously. Not only is fluoroquinolone resistance rising at an alarming rate, but this group of drugs causes resistance to many other antibiotics and is associated with the new more virulent strain of C. difficile we are seeing in the United States.

•Antibiotics used for surgical prophylaxis should rarely be given for more than 24 hours; post-operative doses are not required in many cases.
•Refine your antibiotic choice once culture data is available and always use the drug with the narrowest spectrum.
•Double coverage is rarely necessary once antimicrobial susceptibilities are known.
It is unlikely that new antibiotics will be available in the near future, so we must take the necessary measures to preserve our current supply. Failure to do so will guarantee a return to the pre-antibiotic era.

More practical recommendations can be found in the Compendium of Strategies to Prevent Healthcare Associated Infections, available on at
http://www.shea-online.org/about/compendium.cfm

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CDC - Blogs - Safe Healthcare - Dr. Fishman’s Top 5: Appropriate Antibiotic Use