#StewardTip: The Myths and Realities of Antibiotic Use

Contagion® is talking to antimicrobial stewardship experts to explore the myths and realities of antibiotic use. We'll share a #StewardTip twice a week, so be sure to check back as we add to our list.

Conan MacDougall, PharmD, MAS, BCPS, BCIDP, Professor of Clinical Pharmacy, University of California, San Francisco

"There's a belief that only "inappropriate" antibiotic use can lead to antibiotic resistance. That's not the case - even antimicrobials used for the right indication, dose, and duration can select for resistant organisms."

Brad Langford, BScPhm, ACPR, PharmD, BCPS, Pharmacist Consultant, Public Health Ontario

"In addition to knowledge gaps, think about cognitive biases and behavoiral factors that drive inappropriate prescribing. The answer is not always more education."

Madeline King, PharmD, Professor of Clinical Pharmacy, University of the Sciences in Philadelphia

"Myth: longer is better. Truth: Shorter is almost always better."

"Treating 'just one more day' can have serious consequences (eg C. diff)."

"Get to know your local antimicrobial stewardship team. They aren't just trying to police your antimicrobial usage, but rather are trying to help optimize the care of your patient and others that will require antimicrobials as part of your routine care in the future. No matter your speciality, you have a unique perspective that can be valuably applied to the specialty of antimicrobial stewardship."

"Antibiotic stewardship isn't always about de-escalation. We often recommend escalation of therapy because stewardship is all about best drug for the patient and their bug!"

Amy Hanson, PharmD, BCPS, AQ-ID, Antimicrobial Stewardship Pharmacist at Chicago Department of Public Health

"I realize more now being on the “other side” as I recently transitioned from a large academic hospital (Rush) to public health and have focused on stewardship in skilled nursing facilities and long term acute care hospitals, it’s important to remember stewardship continues beyond the hospital. Broader spectrum agents are often prescribed at discharge for ease of once-daily dosing, when the patient's discharge location might be well equipped to continue the patient on narrower, multiple times/day antibiotics. Think twice, ID stewards, next time approving ertapenem x1 or daptomycin x1 prior to discharge!

Zahra Kassamali Escobar, PharmD, Co-Director of the Antimicrobial Stewardship Program at UW Medicine, Valley Medical Center

"Taking antibiotics to finish a course even if you feel better to "prevent resistance" is just wrong, with a couple of exceptions like tuberculosis."

Timothy P. Gauthier, PharmD, BCPS-AQ ID, Creator of IDstewardship.com and LearnAntibiotics.com

"Antibiotics should always be used with caution. Each dose of unnecessary antibiotics avoided reduces risks."

Nipunie S. Rajapakse, MD, MPH, Pediatric Infectious Diseases Physician, Mayo Clinic - Rochester, Minnesota

"One in ten Americans has been labelled with a penicillin allergy but >90% of them can actually be safely treated with penicillin antibiotics, which have been shown to be the best treatment for many common and serious infections. Taking a detailed allergy history and determining which patients would benefit from an oral challenge or penicillin skin testing is just one of many important ways primary care providers can be antimicrobial stewards."

Zahra Kassamali Escobar, PharmD, Co-Director of the Antimicrobial Stewardship Program at UW Medicine, Valley Medical Center

"A narrow-spectrum antibiotic like cefazolin is extremely effective at killing bacteria and treating infection. Increasing the broadness of coverage (i.e. to pip/tazo) does not mean you’re prescribing something stronger. It just means you’re covering the patient for a wider possibility of bacterial organisms."

Monica V. Mahoney, PharmD, BCPS AQ-ID, BCIDP. Clinical Pharmacy Specialist. Outpatient ID and OPAT Clinic. Beth Israel Deaconess Medical Center, Boston MA

"Antimicrobial stewardship doesn't just end with the workday! It extends well beyond into every day practice. We can have a profound impact by educating our family and friends to avoid unnecessary antibiotics in everyday, casual conversation. Especially now, we can educate that antibiotics have no role in viral infections. Just the other day, I talked my brother out of filling a levofloxacin prescription for the tail end of the flu, because he still 'wasn't better.' A few more days of rest and he was on his way to recovery, sans antibiotic."

"Approach MRSA bacteremia like Cotton-Eyed Joe. Think 'Where did you come from?' (controlling the source) and 'Where did you go?' (looking for metastatic spread)."

Ryan Stevens, PharmD, BCIDP, Infectious Diseases/Antimicrobial Stewardship Pharmacist, Mayo Clinic - Rochester, Minnesota

"Antimicrobial stewardship is best performed by those who take the time to know their institution. Know your data, your successes, your failures, your providers and pharmacists, your advocates, and your holdouts. Then, take everything that you know and target high priority items first leveraging your strengths and building on your weaknesses.

Recognize that sometimes changing practice is a slow, methodical proposition that takes time and persistence. Often bad prescribing habits are developed over time and will take some time to correct. Your work is meaningful. Keep moving forward."

"Antibiotics prescribed in the outpatient setting for things like viral URI or asymptomatic bacteriuria can lead to MDR organisms in more severe infections down the line. Limit antibiotic use as much as possible!"