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VIDEO: Co-chair of IDSA/SHEA stewardship guidelines reviews recommendations
NEW ORLEANS — Tamar F. Barlam, MD, MSc, FIDSA, FSHEA, director of the infectious diseases fellowship program and associate professor of medicine at Boston University School of Medicine, and co-chair of the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America antibiotic stewardship implementation guidelines, discusses the structure of the new recommendations. The guidelines, previously published in Clinical Infectious Diseases, include the most effective strategies promoting optimal use of antibiotics based on existing research.
“The guidelines don’t actually tell the facility which guidelines to implement,” she says. “We tried to give a very practical approach listing a variety of interventions and discussing some of the pros and cons that different facilities might find with those interventions.”
According to the guidelines, health care professionals should:
- conduct preauthorization of certain antibiotics and/or a prospective review of treatment typically 2 or 3 days after initiation;
- avoid relying solely on passive educational activities for ASPs such as lectures or pamphlets;
- implement multifaceted, syndrome-specific interventions vs. improving treatment of all infections simultaneously;
- reduce prescribing antibiotics associated with high risk for Clostridium difficile infections such as clindamycin and/or broad-spectrum antibiotics, including cephalosporins and fluoroquinolones;
- encourage prescribers to routinely review antibiotic regimens;
- employ computerized clinical decision support systems, if possible, that provide clinicians with treatment recommendations when prescribing antibiotics;
- implement pharmacokinetic monitoring for aminoglycosides and vancomycin;
- use alternative dosing strategies vs. standard dosing for broad-spectrum beta-lactams;
- increase appropriate use of oral antibiotics as initial treatment and switch from IV to oral therapy earlier;
- reduce therapy to the shortest effective duration;
- use rapid viral testing for respiratory viruses;
- use rapid diagnostic testing in addition to routine culture on blood specimens;
- incorporate nonculture-based fungal markers to optimize treatment in patients with hematologic malignancy who are at risk for invasive fungal disease;
- monitor antibiotic use by measuring days of therapy (DOTs) vs. defined daily dose (DDD); and
- measure antibiotic costs based on prescriptions or administrations rather than purchasing data.
Disclosure: Barlam reports no relevant financial disclosures.