When penicillin first started to enter everyday use in the 1940s, the antibiotic was considered a miracle. What’s not as well-known is this: even as this revolutionary killer of bacteria began curing infections that had previously taken the lives of countless human beings, some bacteria had already evolved that were resistant to it.
Since then, many new types of antibiotics have been introduced … and bacteria have continued to develop resistance to them.
The spread of antibiotic resistance results primarily from overuse and misuse of antibiotics. David Ezdon, PharmD, clinical pharmacist at Einstein Medical Center Montgomery (EMCM), is working to turn the tide against this growing and serious problem. He started EMCM’s antibiotic stewardship program in 2014, which has resulted in an 18 percent drop in intravenous antibiotic use throughout the hospital. The program educates patients, doctors and health care workers.
Antibiotic stewardship, he explains, is both a program and a strategy endorsed by the Centers for Disease Control and Prevention (CDC) to improve the way in which antibiotics are prescribed and used—which means, he says, “the right drug, the right dose, the right frequency, the right route of administration, and the right indication.” It also means minimizing antibiotic toxicity—antibiotics can cause allergic reaction and side effects, many of them serious, such as Clostridium difficile-associated diarrhea.
Does that mean patients shouldn’t get antibiotics when they need them? No.
“We’re promoting proper antibiotic use,” says Dr. Ezdon. “If you do need an antibiotic, we want to be sure it’s being used properly.”
Here’s an example of “improper use”. Let’s suppose you have a respiratory condition, like the common cold. A cold is a virus. Antibiotics are ineffective against viruses. Therefore, taking an antibiotic to treat a cold is an improper use.
There are many other instances in which antibiotics are ineffective.
“Things like a sore throat, unless it’s a strep throat, these are often viral in nature,” says Dr. Ezdon. “Often when patients have otitis media (an ear infection), that will also be viral as well. Asthma exacerbations are often viral in nature, not bacterial.”
Here’s another example. Suppose you have a genuine need for an antibiotic—let’s use our case above of strep throat. Some people take their antibiotics until they start to feel better, and then save the rest for later use. That’s an improper use. Now imagine you develop signs symptoms of a urinary tract infection and you decide to take your left over antibiotic from your strep throat.
That’s also improper use as only your doctor can decide what antibiotic is right for your infection.
“If you’re giving an antibiotic, you’re killing all bacteria,” says Dr. Ezdon. “You’re not just killing the bacteria that are causing your illness, you’re killing the bacteria that are in your normal gut flora. When those bacteria die, it leaves room for the drug resistant bacteria to grow and take over. Then they can pass their genes from one bacteria to another to transfer that resistance. Even if you are using antibiotics appropriately, you’re at risk of allowing these drug-resistant bacteria to take over. Using antibiotics appropriately will help to slow the rate of drug resistance.”
Why does improper use of antibiotics happen at all? That’s one of the questions Dr. Ezdon’s antibiotic stewardship effort is designed to address. Patients request antibiotics where they might not be needed, and in many cases, doctors feel pressured to prescribe them. Better doctor-patient communication can help with this situation.
“That’s part of the education, teaching doctors how to break down the insistence by the patient,” says Dr. Ezdon.
What’s needed is a way for doctors to find the time to explain why antibiotics might not be prescribed. “That’s part of what we do on the outpatient side,” says Dr. Ezdon.
Patients are encouraged to create a care plan with their doctors. “If the doctor tells you, ‘Hey, you just have a cold, you don’t need antibiotics,’ you should take that information and if you aren’t satisfied, try and create a care plan with your doctor,” advises Dr. Ezdon. “Say you’re not feeling better in three days, what do you do? Set up a plan with the physician to call them and discuss further treatment options, as well as ensuring you’re aware of the symptomatic control.”
In Dr. Ezdon’s experience, patients do respond well to education about the proper information about the risks, benefits, and proper use of antibiotics. “They become extremely engaged,” he says.
Finding a way to get the antibiotic resistance message across, not just to patients but to health care providers, is incredibly important, adds Dr. Ezdon. “If we don’t help slow the incidence of resistant bacteria,” he says, “then someday we’re not going to have options for patients who come in with basic infections.
“Before penicillin was discovered, we had over 90 percent mortality from childhood bacterial meningitis. With antibiotics we have brought that number to less than 15 percent. But we’re looking at going back to those kinds of numbers if we have to go forward without these antibiotics, so we need to ensure we’re using them properly.”