Be a good steward

Antibiotics play a crucial role in health care. They have improved survival rates after trauma, reduced tuberculosis worldwide and made transplants and cancer therapy possible. But, with such greatness comes greater responsibility.

Overuse and inappropriate use are causing life-saving antibiotics to become ineffective against many bacteria. Resistance occurs when the bacteria mutate and become able to defeat the antibiotics designed to kill them, allowing resistant bacteria to multiply. Antibiotic resistance is part of the natural process of evolving bacteria. Resistance can be slowed, but not stopped.

It is very difficult – if not impossible – to kill antibiotic-resistant germs. An antibiotic-resistant infection likely means a long hospital stay and costly and toxic alternative treatments to cure the infection.

Every one of us faces the potential risk of antibiotic-resistant infections. Like no other drug, antibiotic use in one patient can compromise its effectiveness in another patient. The more antibiotics are used, the more quickly bacteria can develop resistance.

Antibiotic resistance poses a deadly threat to health and incurs high economic costs to society. According to the Centers for Disease Control and Prevention (CDC), antibiotic resistance leads to more than 2 million illnesses and 23,000 deaths annually in the United States.

Antibiotic resistance is also increased with the widespread use of antibiotics in agriculture and production of meat, poultry and fish. Veterinary medicine also contributes to resistance through overprescribing for our pets.

In addition to resistance, antibiotics can cause serious side effects. They are the most common cause of drug-related emergency department visits in children and of health-care-associated infections.

Inappropriate prescribing of antibiotics is the most important modifiable risk factor in preventing antibiotic resistance. Nearly half of all antibiotic prescriptions are inappropriate in terms of selection, dosing, duration and unnecessary prescribing, according to the CDC. Arkansas is ranked seventh highest in the nation in the rate of antibiotic outpatient prescriptions dispensed with 1,131 antibiotic prescriptions per 1,000 people, compared to the national average of 836.

This alarming statistic prompted AFMC, in partnership with the Arkansas Department of Health, to work with pharmacists, doctors and infection prevention experts to implement antibiotic stewardship (AS) programs in health care facilities. The program helps doctors improve their prescribing practices to ensure selection of the right drug, dose and duration.

AFMC has worked collaboratively over the past year with more than 58 Arkansas hospitals and nursing homes on how best to introduce and sustain AS efforts. The outcome of this work is an online antibiotic stewardship and infection prevention toolkit available at www.afmc.org/drugsandbugs. The program also funded 60 matching scholarships for Arkansas pharmacists to complete AS certificate training.

Aggressive action by all of us is needed to improve antibiotic stewardship and reduce antibiotic resistance. Play your part by following these proven public health strategies:

• Stay current on all vaccines.
• Wash hands frequently.
• Keep kitchen utensils and countertops clean before, during and after cooking. Avoid antibacterial cleaners and consider reducing use of antibacterial soap, household cleaning products, disposable wipes and hand sanitizer.
• Be patient with viral infections, give yourself time to heal. Don’t pressure your doctor for an antibiotic prescription.
• Be sure you are tested to determine if bacteria or a virus caused your illness. Antibiotics cannot kill viruses but do set you up for future antibiotic resistance. Viruses cause colds, flu, coughs, bronchitis, sore throats (except strep throat) and some ear infections.
• Take all antibiotics exactly as prescribed. Stopping too soon allows bacteria to survive, re-infect and become resistant.
• Think of antibiotics as a precious resource, only used when absolutely necessary. Thinking that, “maybe I don’t need it, but it can’t hurt” is wrong and dangerous.

This short video tells the story of antibiotic misuse.

Editor’s note: Ray Hanley is Arkansas Foundation for Medical Care’s CEO and President and Mandy Palmer is AFMC’s manager of outreach quality. The opinions expressed are those of the author.