Antibiotics have made the single biggest impact on human mortality since their invention in the mid 1900s.
According to Shaefer Spires, M.D., infectious disease physician at Vanderbilt University Medical Center and epidemiologist at Williamson Medical Center, there is no other medical intervention that has had a bigger impact on society.
“Before penicillin, what we refer to as the pre-antibiotic era, a patient could very well die from a simple bacterial infection,” Spires said. “Antibiotics changed that. But now, we are realizing that antibiotics can sometimes cause more harm than good in many cases because of misuse and overuse of these drugs. I read a report recently that suggested if things continue the way they are, in our lifetime more people will die from multi-drug resistant organisms than of cancer.”
Many reports and statistics show that the world is facing a ‘post-antibiotic’ era due to the fact that people are once again dying of infections because of a phenomenon called antibiotic resistance.
Ironically, the inventor of penicillin, Sir Alexander Fleming, predicted this back in the 1940s shortly after penicillin became available by saying: “The thoughtless person playing with penicillin treatment is morally responsible for the death of the man who succumbs to infection with the penicillin-resistant organism.”
Seems a bit melodramatic, but exactly what he feared would happen is happening around the world.
And here’s why.
According to the Centers for Disease Control and Prevention (CDC), studies indicate that 30 to 50 percent of antibiotics prescribed in hospitals are unnecessary or inappropriate and 45 percent of prescriptions written in doctors’ offices are for conditions that antibiotics can’t help.
Studies demonstrate that improving prescribing practices in hospitals can not only help reduce rates of Clostridium difficile infection and antibiotic resistance, but can also improve individual patient outcomes, all while reducing healthcare costs.
But none of this is news to the pharmacists and infectious disease physicians at Williamson Medical Center. An Antibiotic Stewardship Program (ASP) was formed initially in 2009 to address this issue, and their efforts have now garnered some national attention.
In an attempt to bring awareness to the issue of antibiotic misuse and overuse, the CDC has initiated Get Smart About Antibiotics, a campaign focused on improving antibiotic prescribing practices and bringing public awareness to this issue. More information can be found on the CDC web site at http://www.cdc.gov/getsmart.
WMC is leading by example
In a report that came out April 26, 2016, from The Pew Charitable Trusts, Williamson Medical Center is featured as a community hospital that is leading the way in the fight against antibiotic resistance – one of today’s most urgent health threats, both in Tennessee and around the world. Click here to read the report.
“Our initiatives started when an infectious disease physician and a pharmacist recognized this issue needed to be addressed in our community,” said Montgomery Williams, Pharm.D., BCPS, Clinical Pharmacist, Internal Medicine at Williamson Medical Center.
“The program started small by focusing the medical center’s formulary to ensure that we had the right antibiotics available for our physicians to use,” Williams said.
She said from there, the program grew into pharmacists proactively reviewing patients’ profiles for appropriate antibiotic use.
“For a medical center of our size, we have heard from outside healthcare providers time and time again that we are on the forefront of Antibiotic Stewardship Programs,” Williams said. “We are proactively identifying opportunities for change.”
Kristi Kuper, Pharm.D., clinical pharmacy manager for the Gulf States Purchasing Coalition, who has a background in infectious diseases and works with hundreds of hospital ASP committees, said the program at Williamson Medical Center is in the top 10 percent.
“Their highly skilled team combines the latest innovations in technology and the most recent up-to-date medical literature to help guide appropriate antibiotic use which has both an individual patient benefit as well as a community benefit.
The clinical decisions that they are making daily save lives,” Kuper said.
One action Williamson Medical Center has implemented as a result of the ASP is rapid diagnostic equipment that can identify bacteria in the bloodstream within hours, not days.
“Instead of taking 48 hours to get results, we can identify the cause of an infection in the blood in an hour,” Spires said. “That way, we can prescribe the most appropriate antibiotic for that infection or stop antibiotics once we learn it’s not a bacterial infection.”
Spires said in cases where test results can take days, physicians often prescribe an antibiotic on the spot as a “just in case” method, but many times that prescription is unnecessary and can do serious damage down the road including toxic effects on the kidneys, gut microbiology, and liver and increase the patient’s chance for developing resistant infections in the future.
Another growing problem caused by antibiotic overuse is a deadly diarrheal infection called Clostridium difficile or ‘C-diff’. According to the CDC more than half a million Americans suffer from C-diff in a single year and nearly 30,000 of them will die within 30 days of diagnosis.
Receiving an antibiotic is the single biggest risk factor for developing an infection with C-diff.
Tracey Bastian, Pharm.D. and clinical pharmacy manager at Williamson Medical Center, said upon review of a patient with C-diff’s case history, you can trace it back to an antibiotic and wonder if the whole thing could have been avoided.
But since Williamson Medical Center’s ASP has been implemented, cases of C-diff have gone down, as have resistance rates with Pseudomonas, which are bad bacteria that can cause extremely harmful infections.
Although pharmaceutical companies have continued to develop new, antibiotics throughout the years, the bacteria always develop a resistance.
Author and journalist Maryn McKenna, who specializes in public and global health, said simply “evolution always wins.”
“Bacteria birth a new generation every 20 minutes,” she said. “It takes pharmaceutical companies 10 years to derive a new drug. Every time we use an antibiotic, we give the bacteria billions of chances to crack the code of the defenses we’ve constructed. There has never yet been a drug they could not defeat.”
So the responsibility ultimately lies on healthcare providers to be more careful about prescribing antibiotics and the general public to become educated about when antibiotics work and when they don’t. For example, parents don’t demand an antibiotic for their child’s ear infection or the flu – two cases where antibiotics typically won’t work.
The President’s Council of Advisors on Science and Technology prepared a report to President Obama in 2014 that recommends that every hospital nationwide be required to form an Antibiotic Stewardship Program.
The report states that without rapid and coordinated action, the U.S. risks losing the public health progress made over the last century from the discovery and development of antibiotics, thereby threatening patient care, economic growth, public health, agriculture, economic security, and national security.
Williamson Medical Center’s Antibiotic Stewardship Program is proving to be an effective example of how to do it and do it right.Share this Article