Studies by Vail Valley Medical Center, other Colorado hospitals indicate antibiotic overuse
Special to the Daily
antibiotics can save lives, but overuse poses a serious threat to the human body.
Vail Valley Medical Center collaborated with seven Colorado hospitals on a two-year study, which followed 533 children and adults hospitalized for soft-tissue infections.
It was one of four major recent studies VVMC contributed to by measuring antibiotic prescription practices in both rural and metropolitan Colorado regions, evaluating how the state is doing overall.
The research indicated doctors are consistently prescribing antibiotics that are too strong for specific bacterial infections and patients are taking them for too many days, according to Jason Moore, Ph.D., an epidemiologist at VVMC.
Through a comparison of wound and skin cultures, the 533-patient study demonstrated that specific bacteria cultures could often have been effectively treated with a less potent antibiotic, Moore said. The study, which ended in 2012, empowers both patients and physicians to be more cautious when it comes to antibiotic prescriptions.
“VVMC’s vision for excellence in specialized care is realized through important studies like this,” said hospital President and CEO Doris Kirchner. “Our goal is to continue to collaborate with leading researchers to produce evidence-based practices that benefit our patients here in Eagle County and beyond.”
How to handle antibiotics
The first step, Moore said, involves educating the general public about how antibiotics are overprescribed and the danger of such practice. Antibiotics are the most common drugs doctors prescribe, according to the Centers for Disease Control and Prevention. While they can save lives, overuse can lead to harmful, antibiotic-resistant bacteria.
Antibiotic resistance occurs when antibiotics kill both good and bad bacteria, but drug-resistant bacteria remain alive and are able to multiply. Then, some bacteria pass on their drug-resistance to other bacteria, which cause more infection. These ultra-resilient “bugs” pass from person to person, and they also can remain on improperly cooked or handled animal meat and crops.
Nationally, antibiotic-resistant bacteria are responsible for at least 2 million illnesses and 23,000 deaths annually. Still, patients often visit doctors with the expectation of an antibiotic prescription, Moore said.
“We need to instill realistic expectations in patients,” Moore said, “and figure out which diseases need antibiotics. Sometimes no antibiotics (are indicated).”
He said one of the reasons doctors overprescribe antibiotics has to do with patient expectation and pressure. Another involves training.
“A lot of us are taught to be worried about (deadly illnesses), so we (sometimes) jump to the worst-case scenario,” he said, explaining why busy doctors also might overprescribe.
Moore encourages a stronger collaborative partnership between patients and doctors. For example, patients should return to the same doctor if they don’t feel better after the first visit. Instead, they often see another physician, rather than scheduling a follow-up.
“Communication is the cornerstone of every relationship, especially in this case,” he said. “Patients should come to the doors with open ears, and it goes the other way, too; there’s a responsibility for doctors not to succumb to the pressure of prescribing an antibiotic.
“Patients should ask providers, ‘Does this really need an antibiotic?’ versus asking for one. I think that’s the most responsible action.”
Of course, if an ailment — including respiratory illness, for which many patients request antibiotics — worsens rather than improves, antibiotics may be necessary.
One rule of thumb involves remaining hydrated; if patients can’t tolerate liquids, it’s time to see a doctor. Most viral illnesses slowly get better, or stay about the same, within 24 to 48 hours, after which a person may “feel or stay crummy,” Moore said, but does not rapidly decline. On the other hand, serious bacterial infections can take a turn for the worst in a matter of hours or days.
“If symptoms progress or worsen, it needs to be seen,” Moore said.
Be thoughtful stewards
VVMC helps patients navigate the often-confusing process of dealing with disease not only through doctor visits, but also through the hospital’s Antibiotic Stewardship Program, which includes a multidisciplinary medical team that follows patients’ progress and identifies best practices.
Moore helped VVMC stay ahead of the curve by helping launch the Antibiotic Stewardship Program about a year and a half ago. It consists of pharmacists, physicians, epidemiologists and other health-care professionals who track the suitability of specific antibiotics and make changes as necessary while patients are in the hospital.
“Patients can be assured that when they’re being treated, they truly have a multidisciplinary team, in real time, as they’re in this hospital,” Moore said.
The recent antibiotic studies support this concentrated, multidisciplinary approach, but it’s only one important aspect in which VVMC has led the way. Moore has researched traumatic ski and snowboard injuries and more.
He believes in proactive, local clinical research rather than “waiting for the next big paper to come out to show us how to care for people.”
“From a community hospital perspective, it’s on us to do active research,” he said. “Until we know where we are, we don’t know where we want to go. We need to identify what we’re doing right and wrong. The end beneficiary of this is the patient; it directly contributes to improved patient care and patient outcomes.”
Kimberly Nicoletti was commissioned by the Vail Valley Medical Center to write this article for publication in the Vail Daily.