Antibiotics have saved countless lives, but their use is not benign. Furthermore, nearly half of antimicrobials are prescribed for people who don’t need them or are prescribed inappropriately.
“Antibiotics are in a unique class of medications where overuse can harm an entire population of people, whereas underuse may result in serious complications to the individual patient,” said Angela Myers, M.D., M.P.H., FAAP, director, Infectious Diseases Fellowship Program, Children’s Mercy Hospital & Clinics. “It’s all about striking that balance between underuse and overuse.”
Dr. Myers addressed a spectrum of issues pertaining to antibiotics, including resistance, antimicrobial stewardship and clinician impact, in a session at the AAP National Conference & Exhibition titled “Unintended Consequences Related to Antimicrobial Exposures — The Case of Improved Prescribing.”
Antibiotic resistance has been described by the Centers for Disease Control and Prevention (CDC) as “one of the world's most pressing health problems.” Clostridium difficile, for example, infected more than 250,000 Americans in 2013 in both outpatient and inpatient settings, she said.
“Just like in adults, we are seeing more and more cases of Clostridium difficile infection in children, and now it is actually more common for it to be community acquired than hospital acquired,” explained Dr. Myers, a member of the AAP Section on Infectious Diseases.
“But we have a problem. We are developing more resistance with the organisms that have been around a long time but decreasing the new drugs being developed,” she said. “In 1983-1987, there were 16 new antibiotic drugs that came to market for sale in the United States. In 2008-2012, there were two.”
Reports recently have been issued by President Barack Obama (National Action Plan for Combating Antibiotic-Resistant Bacteria, http://1.usa.gov/1LRLnUQ) and the CDC (Antibiotic Resistance Threats in the United States, 2013, www.cdc.gov/drugresistance/threat-report-2013/) with action plans to combat antibiotic resistance. Antibiotic stewardship plays a key role in both.
“Multiple studies support antimicrobial stewardship,” Dr. Myers said. “They have shown that patient outcomes are better, patients are safer by reduced infections, resistance is lowered as well, and costs are lowered without an increase in harm.”
She made recommendations for clinical implementation of stewardship strategies: use stringent rules for diagnosis; determine if antibiotics are needed; obtain cultures when possible to determine pathogens; use local susceptibility data to select medication; and counsel families about course of symptoms and risks of antibiotics.
Dr. Myers also encouraged pediatricians to take the upcoming AAP Education in Quality Improvement for Pediatric Practice (EQIPP) course on Judicious Use of Antibiotics. The course will offer the ability to track use of antibiotics when treating upper respiratory disease, sinusitis, acute pharyngitis and acute otitis media.
“Pediatricians are being called to be leaders in antibiotic stewardship,” she concluded. “Clinicians and their patient care partners hold the solution to integrating these strategies into daily practice and optimizing the care and safety of all patients.”
Resources
- AAP clinical report Principles of Judicious Antibiotic Prescribing for Bacterial Upper Respiratory Tract Infections in Pediatrics, http://pediatrics.aappublications.org/content/132/6/1146
- Visit http://eqipp.aap.org/ to sign up to receive an email when the EQIPP course Judicious Use of Antibiotics is available.
