The High Cost of Antibiotic RedundancyThe High Cost of Antibiotic Redundancy https://pediatricsnationwide.org/wp-content/themes/corpus/images/empty/thumbnail.jpg 150 150 Katie Brind'Amour, PhD, MS, CHES Katie Brind'Amour, PhD, MS, CHES https://pediatricsnationwide.org/wp-content/uploads/2021/03/Katie-B-portrait.gif
- December 23, 2014
- Katie Brind'Amour, PhD, MS, CHES
As many as 78 percent of non-federal U.S. hospitals frequently prescribe redundant antibiotics, according to a study appearing in the journal Infection Control and Hospital Epidemiology. Over a four-year period, these hospitals accounted for 32,507 cases of antibiotic regimens with overlapping antimicrobial spectra, resulting in more than $12 million in avoidable health care expenses.
There are very few clinical situations in which redundant antibiotics are appropriate, but they may be commonly prescribed for a number of reasons, according to Preeti Jaggi, MD, infectious disease clinician-researcher and head of the Antibiotic Stewardship Committee at Nationwide Children’s Hospital. Nearly 150,000 patient days of potentially redundant antibiotics were administered at 394 of the 505 hospitals included in the recent study.
“Lack of physician awareness of the drugs’ overlapping spectra is probably part of the problem,” Dr. Jaggi says. “But there is also a culture in the medical world to treat a wide variety of issues as suspected infection. There are a lot of judgment calls in clinical care, and we need to replace some of those with evidence-based decisions about antibiotic use.”
The absence of documented treatment protocols, dearth of electronic system alerts to detect redundant prescriptions, and failure of health care teams to question a patient’s need for antibiotics may also contribute to the problem, Dr. Jaggi speculates.
There are few new antibiotics to treat increasingly resistant bacteria, which has strengthened advocacy efforts for hospital antibiotic stewardship. In September 2014, the federal government issued an executive order called Combatting Antibiotic-Resistant Bacteria. The executive order includes establishing a national task force to address multiple antibiotic-related issues, such as drug-induced patient harm and the increasing numbers of antibiotic-resistant bacterial infections. That same month, California became the first state to pass a law requiring hospitals to adopt antibiotic stewardship initiatives.
“Creating guidelines for which antibiotics to use and not use in certain circumstances is part of a stewardship committee’s responsibilities,” Dr. Jaggi says. “But training physicians and nurses to change the way they think about antibiotics may be more critical. We need to step back and ask, ‘What do we really think is going on with the patient?’ Often, infection is really low on the list, so we restrain prescribing practices accordingly.”
Restrictions on certain prescriptions or drug combinations could also help quell the problem of redundancy or inappropriate administration of antimicrobial agents that should be reserved for cases in which other antibiotics fail, Dr. Jaggi says. Of the 23 redundant combinations included in the recent study, over 50 percent of cases involved a single grouping: metronidazole and piperacillin-tazobactam. Developing a digital system that flags such a combination as potentially redundant is one step toward stewardship that many hospitals may be able to easily implement.
“We need to raise a culture of awareness about antibiotics,” Dr. Jaggi says. “There can be negative consequences of overuse, so we should be taking the job of prescribing antibiotics much more seriously.”
Dr. Jaggi’s efforts at Nationwide Children’s currently involve the initiation of drug restrictions and the development of antibiotic use protocols in conjunction with experts in each specialty.
- California Department of Public Health. The California antimicrobial stewardship program initiative.
- Obama B. Combatting antibiotic-resistant bacteria. Executive Order, Office of the Press Secretary: The White House. 2014 Sep 18.
- Schultz L, Lowe TJ, Srinivasan A, Neilson D, Pugliese G. Economic impact of redundant antimicrobial therapy in US hospitals. Infection Control and Hospital Epidemiology. 2014 Oct, 35(10):1229-1235.
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