By Jaclyn Skradski, Pharm.D., MPH, clinical pharmacist, UP Health Systems, Marquette; Rachel MacLeod, Pharm.D., PGY2 infectious disease resident, Munson Medical Center, Traverse City and Elaine M. Bailey, Pharm.D., executive director, Michigan Antibiotic Resistance Reduction Coalition
“When I woke up just after dawn on Sept. 28, 1928, I certainly didn’t plan to revolutionize all medicine by discovering the world’s first antibiotic, or bacteria killer. But I suppose that was exactly what I did.” These are the words of Alexander Fleming, the Scottish scientist who first discovered penicillin. In the 90 years since that fateful discovery, many more antibiotics have come to market, and antimicrobial therapy has become a mainstay of modern medicine. However, these vital medications are threatened by antibiotic resistance, a growing public health threat that is in part driven by overuse and inappropriate prescribing. It has been estimated that at least 30 percent of antibiotic prescriptions in the outpatient setting are unnecessary; more recent data suggests this percentage may be even higher, especially for upper respiratory tract infections which are commonly viral in nature.1,2 In addition, it is thought that at least half of outpatient antibiotic prescriptions are suboptimal regarding drug selection, dosing or duration. Similarly, it is estimated that 30 percent of antibiotic use in hospitals is unnecessary or incorrectly prescribed, and use of broad-spectrum antibiotics, such as carbapenems and vancomycin, are on the rise. Ultimately, antibiotic resistance causes more than two million illnesses and over 23,000 deaths each year in the United States. and one in five emergency department visits for adverse drug reactions are due to antibiotics.3
The Centers for Disease Control and Prevention (CDC) has advocated for appropriate antibiotic use for many years. In September 2018, the CDC and partners launched the Antimicrobial Resistance (AMR) Challenge at the United Nations General Assembly, inviting healthcare organizations, pharmaceutical industries and governments worldwide to submit commitments to fighting antimicrobial resistance. Many organizations have already committed to improvements in infection prevention and antibiotic use, tracking and investment in therapeutic and diagnostic developments. The CDC recently launched a four-part, online continuing education (up to eight hours) series titled “CDC’s Antibiotic Stewardship Training Series.” The course reviews the emerging threats of antibiotic resistance and addresses how antimicrobial stewardship in a variety of settings (outpatient, dentistry, emergency departments, hospitals and nursing homes) is essential to fighting antibiotic resistance. The program and other free CE programs can be found on the CDC website at www.CDC.gov/antibiotic-use/community/for-hcp/continuing-education.html.
An important initiative sponsored by the CDC is an annual observance known as U.S. Antibiotic Awareness Week (formerly “Get Smart About Antibiotics Week”), which takes place Nov. 12 to 18. Antibiotic Awareness Week is a great time to promote appropriate prescribing in your practice setting, and the CDC’s website has several resources available for pharmacists looking to help curb inappropriate prescribing practices. Resources include multimedia educational tools for various patient populations, counseling strategies for patients that may be frustrated by not receiving an antibiotic prescription, stewardship program examples and more. Antibiotic awareness can be spread in a multitude of ways, whether directly at your site of work through setting up table clinics with educational information or at home via posting on a favorite social media site. Further ideas to celebrate the week can be found on the CDC website at www.CDC.gov/antibiotic-use/week/index.html.
The Michigan Antibiotic Resistance Reduction Coalition (MARR) is a non-profit organization that seeks to improve the use of antimicrobial agents in communities throughout the state of Michigan through the collaborative educational efforts of academic, government and community partners. One of the more recent initiatives of the MARR Coalition is addressing antibiotic stewardship in dentistry. Dentists are responsible for prescribing about 10 percent of all outpatient antibiotic prescriptions, equating to nearly 25 million prescriptions annually. Slow uptake of guidelines recommending less prophylactic antibiotic use, coupled with a lack of guidelines on managing specific dental infections, accounts for much of the inappropriate prescribing. Brochures were developed to target dental patient populations on the safe use of antibiotics. Provider commitment posters have also been developed for utilization in dental offices. These items, found on the MARR Coalition website at www.MI-MARR.org, make for perfect handouts and displays in dental offices and can be provided upon request.
A legacy MARR Coalition initiative is educational programming developed for the public. There are several school-aged children programs that are freely accessible for anyone to teach students of all ages the differences between bacteria and viruses, how to prevent infection, when treatment for illness is necessary and explanations of antibiotic resistance. Pharmacy students throughout Michigan have been instrumental in sharing the MARR Coalition programs and share that the experience helped them build their skill set as future educators and healthcare professionals.
Antibiotic awareness week is the perfect time to set up a MARR presentation in your community. Anyone can be a MARR ambassador, and it is a great way to volunteer and become involved in the community! All information can be accessed online at the MARR website.
Dr. Tom Frieden, the former director of the CDC, has said, “If we use antibiotics when not needed, we may not have them when they are most needed.” Take time during this Antibiotic Awareness Week to get involved in stopping bugs and saving drugs!
- Fleming-Dutra KE, Hersh AL, Daniel J, Shapiro DJ, et al. JAMA. 2016;315(17):1864-1873.
- Palms DL, Hicks LA, Bartoces M, et al. Comparison of antibiotic prescribing in retail clinics, urgent care centers, emergency departments, and traditional ambulatory care settings in the United States. JAMA Intern Med. 2018;178(9):1267-1269.
- Geller AI, Lovegrove MC, Shehab N, et al. National Estimates of Emergency Department Visits for Antibiotic Adverse Events Among Adults-United States, 2011-2015. J Gen Intern Med. 2018;33(7):1060-1068.