Be Antibiotics Aware:
Use the Shortest Effective Antibiotic Duration
U.S. Antibiotic Awareness Week is November 18th-24th. During this observance, SIDP is highlighting members who promote optimal antibiotic use and combat the threat of antibiotic resistance in impactful and innovative ways. This blog features Dr. J. Drew Zimmer and his antimicrobial stewardship program's initiative to use the shortest effective duration of antibiotic therapy. Learn more from the CDC about using the shortest effective antibiotic duration here.
Briefly describe your antimicrobial stewardship program's initiative to use the shortest effective duration of antimicrobial therapy and why this is important for patient care.
Initiating short course antimicrobial therapy, particularly when clinicians have always been taught 10-14 days for most infections, presented some challenges. We started by educating staff via didactic lectures, face-to-face conversations and email communications. We focused on literature demonstrating short course therapy is safe and effective. We also presented evidence that longer courses of antibiotics are, in fact, more likely to lead to resistance and cause patients harm. Our goal was to make clinicians as comfortable as possible, ensuring them that they were still able to continue longer courses if they felt it was clinically appropriate. We found it was easier to make a recommendation rather than to force a protocol. As more literature came out and clinicians had mounting success with short course therapy, we began to adjust our culture to one where we think, “5 is the new 7”.
How do you educate all hospital pharmacists to evaluate durations of therapy?
This recent publication in Pharmacotherapy by SIDP members succinctly reviews the literature on short course therapy for numerous infections and has been an excellent resource. I have shared it with physicians, pharmacists, and more recently, nurses. There has also been an increase in activity on social media, particularly Twitter, where different manifestations of a short course recommendation chart have been shared. I have urged my non-ID colleagues to join Twitter and follow some of our amazing ID pharmacists who share excellent tidbits and new literature to help educate us all.
What does "Being Antibiotics Aware" mean to you?
First, “Being Antibiotics Aware” means that our efforts to curb inappropriate antimicrobial use are justified. Sometimes I wonder if I am being overly dramatic when I talk about resistance and antimicrobial over usage. However, as we encounter more and more resistance in daily practice, it becomes clear that our work is worthwhile. Second, it means to keep the “magic” of antimicrobials alive. I am a self-proclaimed history buff and have always included the historical significance of antibiotics when discussing them. In my lectures, I discuss survival rates in the Civil War (pre-antibiotics) and World War II (penicillin) to emphasize the miraculous, life-saving effect that antibiotics had. But personally, one of the “stories” I always try to remember is the case study of a child who had facial cellulitis in the early 1940’s. There is a pictorial progression of the patient from day one when she began to receive penicillin to her complete recovery. I try to look at this through the lens of a parent (I have four daughters) and place myself in this time period where, prior to penicillin, these infections were pretty much a death sentence. To these parents, this cure was most likely nothing short of a miracle.
What is another way all pharmacists can Be Antibiotics Aware?
I absolutely love the educational materials provided in the “5 Ways Hospital Pharmacists can be Antibiotics Aware campaign”. I plan on using one each day of Antibiotic Awareness Week (November 18-24, 2019) to provide education on each of the five topics during our pharmacist morning huddle. Then I plan on concentrating on each topic monthly to help give the pharmacists more knowledge of these daily stewardship activities. My hope is that this engagement through education will increase ownership, increase participation in antimicrobial stewardship, and improve antibiotic use and patient outcomes at our institution. I would also highly recommend the SIDP Antimicrobial Stewardship Certificate Program for any pharmacist who is interested. I personally completed the course, and it was well worth it.
J. Drew Zimmer, PharmD, BCPS
Infectious Diseases/Antimicrobial Stewardship Pharmacist
CoxHealth System, Springfield, MO
BS Pharmacy, St. Louis College of Pharmacy
PharmD, University of Colorado Skaggs School of Pharmacy
SIDP Antimicrobial Stewardship Certificate