A pledge of allegiance to antibiotic stewardship

October 6th, 2015

October 6, 2015

By Margie Coloian, MSJ

While antibiotics play a significant role in treating bacterial infections and in preventing and minimizing the spread of disease, they are often prescribed unnecessarily. Such misuse can lead to avoidable side effects like antibiotic resistance, let alone increased healthcare costs.

Last year in the United States, there were more than 11.4 million unnecessary prescriptions for antibiotics written for children.  In childhood, antibiotic use is more dangerous; it is associated with the development of multiple chronic diseases like asthma, allergies, diabetes and other autoimmune conditions.

As conveners for the RightCare Alliance Pediatrics Council, Alan Schroeder, MD and Shawn Ralston, MD, as well as fellow Council members, wanted to focus on this serious issue of medical overuse as part of their activity for RightCare Action Week, October 18-24. Antibiotic stewardship transcends all specialties, primary care physicians, hospital-based physicians, specialists, nurse practitioners or physician assistants—all prescribe antibiotics. The Pediatrics Council decided on an awareness campaign for antibiotic stewardship, which will include development of a pledge for pediatric healthcare providers. The pledge, posted on the Lown Institute web site (www.LownInstitute.org) recommends that pediatric healthcare providers take extra time with families and their colleagues—beginning that week— to discuss the role of antibiotics, if any, in treating children for various conditions. They can then sign the pledge in agreement and solidarity. To facilitate the discussions, the pledge provides the easy-to-remember 5 “Rights”:

  • Right patient: Does the patient truly need an antibiotic for their infection? Do the benefits outweigh the risks?
  • Right drug: Choose the narrowest effective agent for the likely/proven infection; if starting broad, de-escalate as soon as possible
  • Right route: Only use IV route when necessary; transition to p.o. as soon as possible
  • Right dose: Optimize efficacy and compliance while minimizing toxicity
  • Right duration: Provide the shortest possible duration based on the best available evidence

Specific examples of antibiotic stewardship include: “watchful waiting” instead of antibiotics for ear infections, avoidance of antibiotics for viral respiratory infections, and avoidance of prolonged durations of intravenous antibiotics in hospitalized patients after they have improved clinically. Pediatric heath care providers can sign the pledge at any time.

“Sometimes it seems easier to just prescribe the antibiotic and move on to the next patient,” said Schroeder. “However, in most such cases we are causing more harm than good—to the patient, the population and the healthcare system. Thanks to the Pediatric Council, we are able to start this awareness effort now and know other colleagues will support it wholeheartedly,” he said.

Because members of the Council represent various regions, institutions and organizations, it is expected that the pledge will be disseminated far and wide to thousands of pediatricians.

To read and sign the pledge, and view the names of pediatric healthcare providers who have signed on so far, see here.

In addition for RightCare Action Week, Schroeder plans an antibiotics-based RightCare Rounds at his institution, Santa Clara Valley (CA) Medical Center, which will focus on antibiotic overuse in infants with urinary tract infections. So too, does another Pediatrics Council member, Brian Lee, MD, an infectious disease specialist at University of California San Francisco/Children’s Oakland.