Local, federal clinicians work to lower risk of exposure to antibiotic-resistant bacteria | VailDaily.com

Local, federal clinicians work to lower risk of exposure to antibiotic-resistant bacteria

Kirsten Dobroth
Special to the Daily

When was the last time you didn't finish a course of antibiotics prescribed by your doctor? When was the last time you went to the doctor seeking and expecting an antibiotic? And, finally, when was the last time your doctor offered an alternative that didn't involve a prescription to treat something for which you expected an antibiotic?

The answers to these questions might be different for each person, but all are part of the physician-to-patient discussion that is being changed at a national level to combat a rise in antibiotic-resistant bacteria that has been seen globally and nationally. The week of Nov. 14 to 20, in particular, was Get Smart About Antibiotics Week, which is a national push to work with more local clinicians and health care providers in order to encourage more responsible use of antibiotics nationwide.

Cause for concern

In the spring, a Pennsylvania woman was diagnosed with a strain of e-coli that was resistant to colistin, a last-resort antibiotic typically effective at wiping out such infections. While there are other forms of antibiotics available to patients with e-coli infections, the bacteria's resistance to such a powerful drug is something of a warning shot to health experts, as described in the Washington Post's article that appeared on May 27 on the subject:

“The single most important action needed to greatly slow down the development and spread of antibiotic-resistant infections is to change the way antibiotics are used.” Thomas Friedman, M.D., M.P.H.Director of the CDC

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"Colistin is the antibiotic of last resort for particularly dangerous types of superbugs, including a family of bacteria known as CRE, which health officials have dubbed 'nightmare bacteria.' … Health officials said the case in Pennsylvania, by itself, is not cause for panic. The strain found in the woman is still treatable with other antibiotics. But researchers worry that its colistin-resistance gene, known as mcr-1, could spread to other bacteria that can already evade other antibiotics."

This wasn't the first case of colistin-resistant strains of bacteria infecting humans, although it marks a worrisome phase of bacterial evolution that could give rise to harder-to-treat bugs and make routine infections immune to normal treatment plans. The rise of antibiotic-resistant bacterial strains is a multilayer problem that stems from overprescribing physicians and overusing patients and has been linked to meat cultivation that demands widespread antibiotic use for livestock — colistin-resistant strains of bacteria have been found in pork in China, among other places.

Much of the cause for concern doesn't come from the fact that we use antibiotics but that we use them too often, which can leave last-resort treatments useless against bacterial strains that have been evolved immunity against them. This issue is confounded and particularly worrisome to experts since there aren't many last-resort type of antibiotics in development, leaving physicians little to work with if they begin to see more widespread bacterial evolution against our current antibiotic lineup.

According to the Centers for Disease Control and Prevention, "Each year in the United States more than 266 million prescriptions for antibiotics are written in doctors' offices and emergency rooms. Studies show 30 percent of these antibiotics are not needed and can actually be harmful. … The United Nations identified antibiotic resistance as the 'greatest and most urgent global risk' and called on world governments to combat antibiotic resistance in medicine, agriculture and the environment."

National direction, local involvement

At the national level, there's been a change in the discussion on antibiotic use and its implications, largely sparked by the Obama Administration's focus on the subject as a threat to national security. In particular, the Secretary of Defense, Secretary of Health and Human Services and Secretary of Agriculture have teamed together at President Barack Obama's request to create national initiatives that are pushed at a more local level in order to mitigate some of the risks, with Get Smart About Antibiotics Week being one such push to get the public in the know on new measures to curb antibiotic use.

"The single most important action needed to greatly slow down the development and spread of antibiotic-resistant infections is to change the way antibiotics are used," said Thomas Friedman, M.D., M.P.H., director of the CDC, in a statement. "Each year in the United States, 47 million unnecessary antibiotic prescriptions are written in doctors' offices, emergency rooms and hospital-based clinics, which makes improving antibiotic stewardship a national priority."

That's not to say physicians should stop prescribing outright, but health experts are advocating methods that focus on alternative treatments when applicable and changing the patients' expectations when they see a doctor.

Roy Caldwell is a clinical pharmacist and anticoagulation specialist with Vail Valley Medical Center and chairs Vail's Antibiotic Stewardship Committee, which is the local arm of the federal program to curb antibiotic use. He said the federal-level push has increased much-needed discourse on the topic and has led to improved methods of communicating with regional providers about non-antibiotic trends in treatment and the latest updates on the issue from the CDC.

"For the past two years, we've followed what the CDC says, but we're also part of a collaborative with about 30 other hospitals, and it's been invaluable working with other hospitals and program coordinators," he said. "Earlier this year, we put information out to both community and hospital physicians about how to treat different conditions and a quarterly newsletter to help keep our providers apprised of new information."

The committee is also working on implementing a list of "core elements" to help guide both physicians and patients in steering away from antibiotics in certain cases, with initiatives such as a 48-hour reassess, where patients are evaluated for medication needs on a 48-hour basis as opposed to longer-running prescriptions, to cut down on meds.

The committee hopes that improved conversation with local providers can also help inform patients, who might stop courses of antibiotics when they start to feel better or push their doctors for antibiotic treatment plans, which can be just as much part of the problem as an unneeded script.

For more information on the CDC's focus on curbing antibiotic use, and its work with local antibiotic stewardship committees, visit http://www.cdc.gov/getsmart/healthcare.

The facts

• 1 in 5 emergency room visits for adverse drug events are caused by side effects from antibiotics.

• 50 percent of the antibiotics prescribed for acute respiratory infections aren’t needed.

• 50 percent of patients don’t get the recommended antibiotic for their conditions.

• 154 million visits each year to outpatient facilities result in prescriptions for antibiotics.

• In 2014, Nebraska, Arkansas, Louisiana, Mississippi, Alabama, Tennessee, Kentucky and West Virginia had the highest rates of antibiotic prescriptions (all classes) dispensed per 1,000 people (ranging between 1,035 and 1,355 prescriptions per 1,000 people).

• During the same period, Colorado, Montana, Idaho, Washington, Oregon, California, Vermont and New Hampshire all had the lowest rates of antibiotic prescriptions (all classes) per 1,000 people (502 to 705 prescriptions per 1,000 people).

Source: Centers for Disease Control and Prevention