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Improving Antibiotic Prescribing in Hospitals Can Make Health Care Safer

CDC calls on hospitals to use new checklist to improve prescribing practices

A new Vital Signs report from the Centers for Disease Control and Prevention (CDC) shows that clinicians in some hospitals prescribe three times as many antibiotics as clinicians in other hospitals, even though patients were receiving care in similar areas of each hospital.

In addition, about one-third of the time, prescribing practices to treat urinary tract infections (UTIs) and prescriptions for the critical and common drug vancomycin included a potential error — given without proper testing or evaluation, or given for too long.

The report also found that, in hospitals, a 30% reduction in the use of the antibiotics that most often cause deadly diarrheal infections with Clostridium difficile can reduce these infections by more than 25%. The same antibiotics also prime patients for future super-resistant infections.

More than half of all hospitalized patients will get an antibiotic at some point during their hospital stay. The Vital Signs report shows that the most common types of infections for which hospital clinicians write prescriptions are UTIs, lung infections, and suspected infections caused by drug-resistant Staphylococcus bacteria, such as methicillin-resistant S. aureus (MRSA).

To help hospitals develop antibiotic prescribing improvement programs (also called antibiotic stewardship programs), the CDC released practical tools that include seven key elements, a self-assessment checklist, and an in-depth implementation document.

The CDC recommends that every hospital implement a stewardship program that includes seven core elements:

  • Leadership commitment: Dedicate the necessary human, financial, and IT resources.
  • Accountability: Appoint a single leader responsible for program outcomes. Physicians have proven successful in this role.
  • Drug expertise: Appoint a single pharmacist leader to support improved prescribing.
  • Act: Take at least one prescribing improvement action, such as requiring reassessment of prescriptions within 48 hours to check drug choice, dose, and duration.
  • Track: Monitor prescribing and antibiotic resistance patterns.
  • Report: Regularly report prescribing and resistance information to clinicians.
  • Educate: Offer education about antibiotic resistance and improving prescribing practices.

It is also critical to work with other health care facilities in the area to prevent infections, transmission, and resistance, the CDC says.

“Today’s antibiotics are miracle drugs, but they are endangered,” said Arjun Srinivasan, MD, a medical epidemiologist at the CDC. “These new materials provide core elements and practical tools for beginning and advancing antibiotic stewardship programs.”

Source: CDC; March 4, 2014.

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