While antibiotics can be life-saving for patients with deadly infections and are an effective means of treatment in a wide range of medical scenarios, they also tend to be over-prescribed. According to the U.S. Centers for Disease Control and Prevention (CDC), between 20 and 50 percent of the antibiotics prescribed in hospitals in the United States are “either unnecessary or inappropriate." It's a trend, the CDC notes, that has led to antibiotic resistance, “one of the most serious and growing threats to public health."1
To help combat over-prescribing, the CDC encourages hospitals to develop antibiotic stewardship (ABS) committees and recommends that laboratory staff and pharmacists be actively involved. Here's a look at how an ABS committee—and the lab and pharmacy in particular—can help physicians to better understand that “more antibiotics" isn't always the best answer.
A Difficult Problem
Physicians who over-prescribe antibiotics, says Michael Broyles, director of pharmacy and laboratory services at Five Rivers Medical Center in Pocahontas, Arkansas, often do so because they believe not prescribing could be even worse. “When a patient is bad, you don't know what else to do, you give them antibiotics. The mentality is, 'Just to make sure.'" Doctors, he explains, are susceptible to remembering the patient who did poorly because of something they missed. “So we make decisions based on that one bad outcome, thinking we have to cover everybody."
Edward Septimus, MD, FIDSA, FACP, FSHEA, clinical professor at Texas A&M College of Medicine, agrees. “One of the things that drives unnecessary and prolonged care is diagnostic uncertainty." Infectious disease physicians who don't have the information they need to understand for sure what they're seeing in a patient may decide to prescribe right away rather than wait for test results to come in. “Sometimes that first dose of an antibiotic is being hung before the phlebotomist has come to do blood cultures," Dr. Septimus says.
