CDC Update on US Antibiotic Use Highlights Challenges, Opportunities: Public Health Watch

America has made “some progress” in the fight against infections caused by antibiotic-resistant bacteria and efforts to encourage proper prescribing of the drugs designed to treat them, according to the US Centers for Disease Control and Prevention (CDC). However, plenty of room for improvement remains.

Indeed, this is the essential finding of new 2018 update to the agency’s landmark report “Antibiotic Use in the United States: Progress and Opportunities.” The documents are all part of the CDC’s Antibiotic Resistance Solutions Initiative, which was initially sanctioned and funded by Congress in 2016, and the latest missive comes on the heels of Sen. Sherrod Brown’s (D-Ohio) decision to reintroduce the Strategies to Address Antibiotic Resistance (STAAR) Act.

“Antibiotics do a world of good…fighting infections and illness, but now antibiotics are becoming less effective, putting people at risk from dangerous infections that can’t be cured,” Brown told ABC-6 in Columbus. “We should address this growing crisis head on, both to stop the spread of deadly superbugs and to preserve antibiotics as a tool to fight disease.”

According to the CDC’s updated report, at least 30%—or 47 million courses—of all antibiotic prescriptions in the US are unnecessary despite enhanced stewardship efforts at health care institutions across the country. And, of the 4992 acute care hospitals that responded to the 2017 National Healthcare Safety Network (NHSN) Annual Hospital Survey, 76.4% indicated that they had adopted all 7 of the CDC’s Core Elements of Hospital Antibiotic Stewardship Programs—still significantly short of the goal of 100%, set for next year.

Of course, overuse of antibiotics is the main driver behind the development of resistant bacteria. The CDC’s update cites data from a study published in July 2018 in JAMA Internal Medicine, which indicates that 46% of health care providers in outpatient settings still prescribe antibiotics for respiratory illnesses such as the common cold and bronchitis. The report also highlights data from a study published in January 2018 in Clinical Infectious Diseases that indicates that 5% of all fluoroquinolone antibiotics prescribed for adults in medical offices and hospital emergency departments are unnecessary and that 1 in 5 prescriptions within the drug class “were not the recommended first-line treatment” (ie, for urinary tract infections or sinusitis). Fluoroquinolones were even prescribed for colds and bronchitis, the study found, and, notably, their use has been linked to Clostridioides difficile infection, among other adverse events.

Additionally, the updated report includes data suggesting that many antibiotics in the US are prescribed for durations longer than recommended by currently accepted treatment guidelines. These therapies were being used for the treatment of sinusitis and community-acquired pneumonia, among other infections.

Because of these and other similar prescribing patterns, the CDC is “actively collaborating” with the Urgent Care Association (UCA) and other organizations “to identify successes, challenges, and opportunities for improvement related to antibiotic use.” However, it appears the agency has its work cut out for it, at least if the findings of a study published on August 16^th by the JAMA Network are any indication. Initially, the study was designed to assess the “feasibility” of 2 Infectious Diseases Society of America-recommended antimicrobial stewardship interventions—preauthorization (PA), in which prescribers were required to receive pharmacist approval for continued use of an antibiotic after the first dose, and post-prescription audit and review (PPR), in which the pharmacist would engage the prescriber about antibiotic appropriateness following 72 hours of therapy—at 4 community hospitals in North Carolina (median bed size 305), but the researchers abandoned the PA intervention at study onset over concerns that clinicians would not want to have prescriptions restricted.

“CDC uses data to guide efforts to promote appropriate use when antibiotics are needed and reduce unnecessary antibiotic use,” the agency said in the updated report. “To accelerate improvements, support innovation, and help health care facilities and providers make the best decisions to treat and protect their patients, CDC provides technical expertise and tools for implementation, data for action, and educational resources.”

But will it be enough? Stay tuned…