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Antibiotics require targeted approach
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SAN DIEGO — Clinicians should use a targeted approach for antibiotic therapy that maximizes antimicrobial effectiveness and limits unnecessary antimicrobial use, according to a presentation at the ACP Internal Medicine Meeting.
Appropriate antibiotic use is crucial in reducing adverse drug events and toxicity, superinfection and excess mortality and costs, Trish M. Perl, MD, FACP, Jay P. Sanford Professor of Medicine and the chief of infectious diseases at the University of Texas Southwestern Medical School and Medical Centers, said during her presentation. According to Perl, there are several questions clinicians should ask themselves when initiating antibiotics:
- Is an antibiotic indicated based on clinical findings?
- Have appropriate cultures been sent before starting antibiotics?
- What is the appropriate empiric therapy based on the most likely pathogens?
- Are there important host factors to consider?
- What is the best drug dose and route of administration?
- What is the anticipated duration of therapy?
“We really want to promote getting the right drug for the right bug at the right time and right dose for the right duration,” she said.
She outlined several best practices for prescribing antibiotics: Clinicians should optimize the dosage and route of antibiotic administration either through therapeutic drug monitoring, continuous or extended infusions or IV-to-PO switches. They should also avoid double anaerobic coverage; however, Perl noted a few exceptions, including using metronidazole for the treatment of Clostridium difficile infection or clindamycin for toxic shock syndrome or necrotizing fasciitis.
It is importance to have an “antibiotic timeout” for 48 to 72 hours to reassess the clinical status and culture results to determine whether the patient really needs the drug, she said. This timeout consists of de-escalating or stopping antibiotics or shortening the duration of therapy, according to Perl. In addition, clinicians should avoid prescribing antibiotics for inappropriate indications or when little or no potential benefit is foreseeable, she said.
It is also important for clinicians to educate their patients on when antibiotics are and are not effective by discussing indications, appropriate use and risks of antibiotics, recommending specific symptomatic therapy and a back-up plan, as well as constructively correcting false popular beliefs, Perl said. She also stressed the importance of collaborating with infectious disease specialists, pharmacists and stewardship teams.
“Antibiotics are an important shared resource and the ways that we use them matter now and for the future,” Perl said. “We need to understand and respect the consequences of antibiotic misuse or overuse and gain confidence in the benefits and ability to use antibiotics wisely.” – by Alaina Tedesco
Reference:
Perl TM. MTP 064: Antibiotics: What Everyone Needs to Know. Presented at: ACP Internal Medicine Annual Meeting; March 29-April 1, 2017; San Diego.
Disclosure: Perl reports being on the advisory board for Pfizer and DebMed and receiving grants from Medimmune and the Biomedical Advanced Research and Development Authority.