Willy-nilly’ prescribing: Main bug-drug problem
Efforts to lessen the dangers of antibiotic resistance must be tailored to the individual hospital, according to an ongoing Intensive Care Antimicrobial Resistance Epidemiology (ICARE) study."There isn’t going to be one size that fits all," says John E. McGowan Jr., MD, professor of epidemiology at the Rollins School of Public Health at Emory University in Atlanta, which is conducting the study along with the Centers for Disease Control and Prevention. "It’s going to require looking at what is going on in the specific institution or health care system and making plans accordingly. Benchmarking from the data will be useful, but that benchmarking is going to have to be turned into local circumstances to be either effective or cost-effective,"
In the interim, an obvious general area to review is empiric prescribing for patients without a definitive diagnosis, Archibald notes.
"A lot of that is subjective," he says. "If we could control that so doctors [are not] prescribing willy-nilly for every fever — but that is a difficult proposition. How can someone tell doctors how to prescribe?"
As a general guide, clinicians may want to consider the following recommendations for control of antibiotic use in the ICU by Dennis Maki, MD, chief of infectious diseases at the University of Wisconsin Hospitals and Clinics in Madison.5
• If fever is the patient’s only sign of infection, the patient should not automatically be placed on an antibiotic.
• For treatment of a presumed infection, appropriate diagnostic tests, such as cultures, should always be done before starting antibiotics.
• A single drug and the most narrow-spectrum drug or drugs should be used whenever possible, especially if the infecting organism or organisms are known at the outset.
• Reassess the need for continued antimicrobial therapy daily and modify therapy based on culture results.
• Don’t extend surgical antimicrobial prophylaxis beyond 24 hours postoperatively. Patients undergoing most surgeries can receive a single dose of preoperative antibiotic.
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