Antibiotics save lives, but they aren’t always the answer.
That’s the message from the Centers for Disease Control and Prevention’s “Be Antibiotics Aware” effort. Federal rules that took effect last year require health care organizations to help doctors, nurses, other medical staff and patients understand the negative health effects and financial costs of drugs that are prescribed but not needed.
The rules apply only to people who spend at least one night in the hospital. Sanford Health pharmacists in Rock Rapids, Iowa, extended the effort beyond the hospital setting by encouraging fewer needless prescriptions in clinics.
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Though antibiotics treat numerous illnesses caused by bacteria, they do nothing for viruses and increase a person’s risk for:
- Side effects
- Antibiotic-resistant infections
- Infections that can cause diarrhea or deadly colon inflammations
The CDC, which implemented the guidelines, estimates that at least 47 million antibiotic prescriptions each year are unnecessary.
The CDC called the situation “a public health crisis.” The World Health Organization said it’s “a major threat to human health.” The Department of Defense went so far as to call it “a threat to national security” because of the growing problem of antibiotic resistance in humans and animals.
“We’ve had some success fighting antibiotic resistance but, if we don’t all act fast together, we will see global progress quickly unravel,” Alex Azar, Health and Human Services secretary, said in challenging other countries to join the effort.
Patients demand drugs
But American health care organizations find themselves in a bit of a predicament.
They are now reimbursed based largely on patient satisfaction surveys. While that does create an incentive to provide quality care, a report in the Journal of the American Medical Association found that patients score doctors poorly if they don’t prescribe antibiotics — regardless of whether the drugs would help.
In other words, some patients would rather take a medication even if it does nothing to help and might actually harm them.
What helps to relieve symptoms of a virus?
- Extra water and fluids
- A vaporizer or saline nasal spray to relieve congestion
- Ice chips, sore throat spray or lozenges for sore throats
- Cough drops to relieve a cough
- Over-the-counter pain medications
Virus vs. bacteria
Here are some common illnesses, whether the usual cause is a virus or a bacteria and whether an antibiotic is needed to treat them:
Bacteria (antibiotic needed):
- Whooping cough
- Strep throat
- Urinary tract infection with symptoms such as fever, pain or more frequent urination
Virus (no antibiotic needed; treat the symptoms):
- Cold or runny nose
- Bronchitis or chest cold in an otherwise healthy person
- Sore throat (except strep)
- Fluid in middle ear
Costs of unneeded prescriptions
Beyond the personal impact to each patient, data from the CDC and American Journal of Medicine show the societal and financial cost of excessive antibiotic use in the U.S.:
- More than 2.8 million antibiotic-resistant infections occur in the U.S. each year
- More than 35,000 people die as a result of antibiotic-resistant infections
- Of the more than half of all hospital patients who receive an antibiotic, 30-50 percent are unnecessary or inappropriate
- Of those patients, the impact of those antibiotics increased the average hospital stay by 4.2 days and charges by $5,638
Health care organizations could be disciplined if they don’t meet certain benchmarks in the CDC requirement of promoting public awareness of antimicrobial stewardship.
To help meet those targets, Sanford Rock Rapids led the effort to implement changes at the medical center to create that accountability:
- Link the illness to the preferred antibiotic through prescribing guidelines.
- Track certain diagnoses and the antibiotics prescribed, if any, at each visit. This determines if providers followed the guidelines or if they prescribed antibiotics that weren’t needed.
- Establish a committee that meets routinely to share how doctors are doing at following the guidelines.
- Report that data to the CDC.
- Educate leaders, doctors, nurses, staff and patients about the antibiotic stewardship effort.
For pharmacists, the net effect of the CDC guidelines will be to tap their knowledge about antibiotics on the market to help providers make better prescribing decisions, regardless of what patients want.