Advances in optimizing the prescription of antibiotics in outpatient settingsBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k3047 (Published 12 November 2018) Cite this as: BMJ 2018;363:k3047
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The authors have raised a very important and relevant issue in this article. The rapid emergence of resistant bacteria is occurring globally and is endangering the efficacy of antibiotics, which have saved a large number of lives for the last so many years. Bacterial infections have become a threat again after many years. It is due to the overuse and misuse of these antibiotics. The Centers for Disease Control and Prevention (CDC) has described a number of bacteria as presenting urgent and serious threats. It is the need of the hour that the new policies are implemented and special efforts are done in this direction to manage this crisis.
In this article, the authors have rightly highlighted that at least 30% of antibiotics used are unnecessary and the reasons for this overuse could be fear of complications and patient expectations mainly. As is well known. besides the risk of developing resistance, a number of side effects can occur with the use of antibiotics. Antibiotic resistance can be avoided by using antibiotics rationally and strictly restricting their use to conditions where benefit outweighs the risk. Keeping a vigil on the disease and prescribing only in case of actual need as suggested would be a better strategy than overenthusiastic use of these medications. A good doctor-patient relationship, counselling and reassurance of the patient about the course of disease can be a successful step in curbing the use of antibiotics. Hence, the role of doctor and patient is equally important in stopping the crisis of antibiotic resistance.
Competing interests: No competing interests
King and his colleagues discuss progress in improving the prescription of antibiotics in outpatient clinics; 1 I would like to take this opportunity to highlight the importance of antimicrobial stewardship in healthcare quality improvement.
Up to 50% of the use of antibiotics in hospitals is unnecessary and inappropriate; we know that most diseases are caused by two types of germs: bacteria or viruses. Antibiotics can only treat bacterial infections. When antibiotics are used incorrectly, they can become less effective, increase length of hospital stay, increase costs for patients, hospitals, defenders and improper use of antibiotics, especially overuse, makes it difficult to treat many diseases with increased toxicity risk as well Increase the resistance of antibiotics. In humans or animals, approximately 80-90% of ingested antibiotics are not broken; they pass through the body intact and enter the environment as waste. Thus, they retain their ability to influence bacteria and enhance resistance to antibiotics even after entering soil or water as a waste product. 2
When using antibiotics please consider: Why? Which drug? What is the dose? What duration?
Antimicrobial Stewardship is a comprehensive antimicrobial management program designed to improve patient outcomes from infection while minimizing adverse effects such as healthcare associated infections and limiting the development of bacterial resistance. Ii is a multidisciplinary approach that focuses on optimal diagnosis, drug selection, dosage, de-escalation and duration so called 5 “Ds” of antimicrobial stewardship.
Goals of Antibiotic Stewardship Program:
- Optimize antibiotic therapy by ensuring the selection of the most appropriate agent, dose, and duration of therapy
- Screening for significant adverse drug reactions and drug–drug interactions
- Modifying initial therapy based on patient’s culture and sensitivity reports.3
Strategies to improve antimicrobial prescribing:
1. Restrictive strategy uses interventions that either prevent or provide a ‘barrier’ to prescribing or administering an antibiotic.
2. A persuasive strategy uses interventions that attempt to persuade healthcare professionals to prescribe appropriately by addressing underlying knowledge deficiencies and/or attitudes and/or behaviors.3
1- https://doi.org/10.1136/bmj.k3047 BMJ 2018; 363 doi cite this as: BMJ 2018; 363:k3047
3- https://www.hamad.qa/EN/All Events/mefqsh2016/presentations/Documents/14may/A4_B4_Antibiotic%20Stewardship_Jameela%20AlAjmi.pdf.
Competing interests: No competing interests