U.S. Antibiotic Awareness Week – an annual one-week observance to raise awareness of the threat of antibiotic resistance and the importance of appropriate prescribing and use – is November 13-19, 2017.
This is a good time to reflect on key takeaways from the Infectious Disease Week (IDWeek) Conference, held earlier this fall in San Diego, where there was a great deal of discussion around inappropriate antimicrobial use and its impact on antimicrobial resistance around the globe.
In the past, IDWeek’s primary focus has been on introducing new antibiotic and antifungal drugs, but the theme of antimicrobial stewardship has become more and more dominant over the years.
There is good reason for this change in focus. According to the Centers for Disease Control and Prevention (CDC), an estimated 2 million people become infected with bacteria resistant to antibiotics and at least 23,000 people die each year as a direct result of these infections. In addition, CDC estimates antibiotic resistance costs $20 billion in excess health care costs in the U.S. each year, with costs to society for lost productivity reaching as much as an additional $35 billion.
While the need to continue inventing novel antibiotics will never end, targeting the ‘cause’ of this worldwide antibiotic resistance is as important as innovations in new drug development. We need to protect and preserve the current and future generations of antibiotics through the use of technology designed to help reduce and ultimately eliminate inappropriate prescribing. If we are unable to address this underlying cause of resistance, the speed and spread of resistance will most certainly outstrip our ability to develop new antimicrobials to address it.
Here are three key takeaways from the conference:
• Research alone will not stop the problem – we have to address prescribing habits. Research and development of new antibiotics is a national health priority, but until we deal with prevalent and myriad prescribing errors, which include overprescribing antibiotics, prescribing the wrong antibiotics, the wrong dose and the wrong duration, we can't properly address antimicrobial resistance. One important step towards reducing inappropriate prescribing has to do with the improvements being made in rapid bacterial and fungal diagnostics including antibiotic susceptibility testing (AST).
• Speed and readiness are imperative: It is critical that we get the right antibiotic started in a timely way for any infection. In the past, the diagnostic tests that help providers choose the right antibiotics took a great deal of time to complete – in most cases three to four days. These diagnostic tests are now much faster. To realize the full value of this rapid turnaround time, we need effective and actionable communication for every rapid diagnostic result. Today’s technology solutions play a critical role in ensuring that appropriate medication changes are made based on the latest diagnostics available to hospital labs in near-real-time. For instance, in cases of drug-bug mismatches, technology can now let providers know directly and quickly that an immediate change is needed. It can also measure how long it takes from the moment a prescribing decision is made to the time it actually takes for the new medication to be administered. Today this can sometimes take a few hours, but technology can improve that.
• Patients must have the correct antimicrobial on-board by the time of the second dose. The provider’s first antibiotic choice has to be made empirically with very little information. Because of this, as many as 50 percent of these initial empirical choices can be incorrect: Either the patient is prescribed the wrong antibiotic, the wrong dose, or quite simply did not need an antibiotic to begin with. Therefore, it is of paramount importance that we get the right results and determine the correct medication by the time the patient needs a second dose, which is typically eight to 12 hours after the first one. Appropriate targeted therapy has been demonstrated to improve patients’ clinical outcomes and in most cases reduce the length of stay in the hospital.
Clearly, doing nothing is no longer an option. By providing innovative technology and services leveraging clinical decision support and electronic patient data in near-real-time, we should be able to greatly reduce the impact of inappropriate antimicrobial prescribing, and positively impact both patient and hospital outcomes. Every hospital and acute-care center can and should have a program utilizing these types of technology.
By Paul Edwards, managing director, ILÚM Health Solutions, part of Healthcare Services & Solutions, LLC, a wholly-owned subsidiary of Merck & Co., Inc.
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