Antibiotic stewardship: The FP’s role
Drug resistance is an expanding problem in outpatient settings. The text and tables that follow can help you fight it by adhering to optimal prescribing guidelines.
PRACTICE RECOMMENDATIONS
› Manage uncomplicated cutaneous abscesses caused by community-acquired methicillin-resistant Staphylococcus aureus with incision and drainage alone. A
› Treat upper respiratory infections associated with drug-resistant Streptococcus pneumoniae with high-dose amoxicillin, which has been found to overcome penicillin resistance. A
› Administer dual therapy with ceftriaxone and azithromycin to patients with gonococcal infections. B
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
Get Smart promotes appropriate antibiotic use by prescribers and aims to decrease demand for antibiotics by patients and promote adherence to prescribed antibiotic regimens. Studies have found that incorporating treatment algorithms and clinical decision support systems into existing electronic medical record systems has led to more appropriate prescribing.37-39
The most effective interventions target both patients/parents and prescribers, provide evidence-based prescribing prompts, require prescribers to justify antibiotic use, and involve clinicians in their design. Future directions should include collaboration with municipal or regional public health organizations to identify community-wide critical infections and resistance trends and strategies that use behavioral interventions to address inappropriate prescribing.40
…and what you can do
Family physicians are key to determining the outcome of the war against antibiotic resistance. See “Combatting antibiotic resistance: A call to action for FPs” on the previous page for specific interventions you can initiate without delay.
The tide will turn only through modification of both prescriber and patient behavior and formalized programs in our communities. Education about appropriate use needs to be included in medical school curricula and continue in the clinic setting through education of physicians in training, medical students, and office staff.41 Become an advocate by promoting the principles of optimal antibiotic stewardship as outlined by the recent IDSA Guidelines for Implementing an Antibiotic Stewardship Program.42 Go to https://cid.oxfordjournals.org/content/62/10/1197.long to learn more.
CORRESPONDENCE
Dora E. Wiskirchen, PharmD, BCPS, Department of Pharmacy Practice & Administration, School of Pharmacy, University of Saint Joseph, 229 Trumbull Street, Hartford, CT 06103; dwiskirchen@usj.edu.
