Combating the Antibiotic Resistance Epidemic

Michael J. Cawley, PharmD, RRT, CPFT, FCCM, is a professor of clinical pharmacy at the Philadelphia College of Pharmacy, University of the Sciences. He has more than 25 years of experience practicing in the areas of medical, surgical, trauma, and burn intensive care as both a critical care clinical pharmacist and registered respiratory therapist.
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Due to the widespread clinical practice of overprescribing, antibiotic resistance will develop into an even greater national epidemic unless strategies are put in place to optimize antibiotic prescribing and monitoring. Recent data has shown that at least 30% of antibiotic prescriptions in ambulatory care settings in the US from 2010-2011 were unnecessary.¹ The National Action Plan for Combating Antibiotic-Resistant Bacteria set a goal to reduce inappropriate outpatient antibiotic use by 50% by 2020.²

Otitis media (OM), pharyngitis, and sinusitis are three major sources for antibiotic prescribing, accounting collectively for nearly one-third of all antibiotics prescribed in outpatient settings. Recently, data from 2010-2011 was analyzed of 5200 adult and pediatric patients who received first-line antibiotic therapy for treatment of OM, sinusitis, and pharyngitis. Physician prescribing of first-line antibiotics ranged from 37% for adults with sinusitis and pharyngitis to a high of 67% for pediatric patients with OM. For all three conditions overall, use of the first-line agent was 52%.¹ Based upon these results, a recent letter explained that the study provides substantial evidence of overuse of antibiotics for 3 of the most common ambulatory care conditions that collectively account for more than $40 million antibiotic prescriptions annually.³ The letter suggests that there is not just a problem with inappropriate prescribing but also selection of inappropriate antibiotics.

Pharmacists have been a key component in the inpatient antibiotic stewardship initiative. Many hospitals in the United States have initiated antibiotic stewardship programs and have published significant amounts of data on the value of pharmacists in these programs. However, these programs have been primarily focused on the inpatient setting. It is time for pharmacists to have a more active role in the ambulatory and outpatient care setting. Unless these antibiotic stewardship programs are also promoted and initiated in the outpatient setting, data on overprescribing and misuse of antibiotics will continue to rise, exacerbating our antibiotic resistance epidemic.

References

1. Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010-2011. JAMA. 2016;315(17):1864-1873.
2. The White House. National action plan for combating antibiotic-resistant bacteria. https://www.whitehouse.gov. Accessed Oct 18, 2016.
3. Hersh AL, Fleming-Dutra KE,, Shapiro DJ et al. Frequency of first-line antibiotic selection among US ambulatory care visits for otitis media, sinusitis, ad pharyngitis. JAMA Internal Medicine. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2571613. Accessed Oct 19, 2016.