Issue link: https://beckershealthcare.uberflip.com/i/653703
35 ANTIBIOTIC RESISTANCE & STEWARDSHIP we do and all of our recommendations are evidence-based. If there's guidance in the literature, we can do some educating and in turn the specialty physicians can educate us. We perform periodic evaluations for any intervention we make to make sure we're getting the desired effects, so once physicians are able to see that process, we're able to give them a lot of data on their antibiotic use too. It's really a give and take and over time we're able to work together and find the best road to take. Q: Your antibiotic stewardship program has a strong social media presence; is that important for patient buy-in and education? JP: Our Facebook page and Twitter feed were created in 2014 as part of a social media project we undertook to educate our internal medicine residents. As part of that, we ended up doing a lot of education and outreach all over the country. I think patient education and lay public education is enormously important because these are the people we're treating and we're going to see more and more stewardship going from inpatient to outpatient hopefully in the next couple of years. In terms of patient education, it's really about creating a partnership and devising a plan because the patient will decide which antibiotic they do or don't want to take — if we recom- mend they shouldn't take an antibiotic but they really want it, they can just go to the next place and they'll get it. So I think patient education is very high on the list of important jobs of hospital systems and stewardship programs in making sure people understand we aren't abandoning them. If we don't think antibiotics are necessary for a patient who wants them, there are a lot of ways to meet in the middle with them. I think as long as you're communicating about it, they're usually happy to hold off on a prescription. Q: Do you think there is a bare minimum protocol hos- pitals should have in place for antibiotic stewardship? JP: Restriction alone is not stewardship. I really think you need a dedicated person, or even better, a dedicated team, to handle stewardship. I think a dedicated physician and pharma- cist partnership that has time to just focus on stewardship is very important. e pharmacist is an antibiotic expert in terms of mechanism and use and handles a lot of the day-to-day ac- tivities in restriction and monitoring along with the physician. It's really important to have that physician there for clinical cor- relations, to be able to reach out to other physicians and affect change. An infectious disease specialist is ideal for that role. Q: Do you think hospitals can affect significant change as awareness about antibiotic resistance grows? JP: I think you have to look at the hospital itself and also look at a regional model of stewardship. We have patients who are contained with our hospital system. ey visit the same clinics and facilities and we're able to follow their paths and monitor how we're using antibiotics. But outside of that, in the real world, especially in agriculture, bacterial resistance is ev- erywhere. And I think over time we're going to see stewardship branch out more and more from just the hospital to the nursing homes to clinics and other hospitals in the region. We use a kind of grid called an antibiogram to look at all of our bacteria on one axis versus our antibiotics on the other to determine what our level of resistance is. I think over time the antibiograms from different areas are getting more and more similar, and we're getting more and more data that there is a lot of community-acquired resistance. Stewardship at specific hospital institutions is just one place to start, but over time we need to look more broadly to control the spread of resistant organisms. n CDC, American College of Physicians Issue New Guidelines on Antibiotic Prescription By Max Green A ddressing physician mishandling of antibiotic testing and prescription is a key focus of new clinical guidelines for antibiotic stewardship issued by the CDC in partnership with the American College of Physicians. The guidelines are pub- lished in the Annals of Internal Medicine. The paper includes four pieces of "high-value care advice": 1. Clinicians should not perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected. 2. Clinicians should test patients with symptoms suggestive of group A streptococcal pharyngitis (for example, persistent fevers, anterior cervical adenitis and tonsillopharyngeal exudates or other appropri- ate combination of symptoms) by rapid antigen de- tection test and/or culture for group A streptococcus. Clinicians should treat patients with antibiotics only if they have confirmed streptococcal pharyngitis. 3. Clinicians should reserve antibiotic treatment for acute rhinosinusitis for patients with persistent symp- toms for more than 10 days, onset of severe symp- toms or signs of high fever (>102.2 °F) and purulent nasal discharge or facial pain lasting for at least three consecutive days, or onset of worsening symptoms following a typical viral illness that lasted five days that was initially improving (double sickening). 4. Clinicians should not prescribe antibiotics for pa- tients with the common cold. "Inappropriate use of antibiotics for acute respira- tory tract infections is an important factor contributing to the spread of antibiotic-resistant infections, which is a public health threat," ACP president Wayne Riley, MD, said in a news release accompanying the guidelines. "Reducing overuse of antibiotics for ARTIs in adults is a clinical priority and a high-value care way to improve quality of care, lower healthcare costs and slow and/or prevent the continued rise in antibiotic resistance." n