12 Oct Getting Serious About Antimicrobial Stewardship

It’s been over a half-century since the medical community first heard a cautionary reminder from Sir Alexander Fleming (who discovered penicillin) about avoiding overuse of antibiotics.

In the last decade, the clarion call for judicious antibiotic use swelled to world-wide attention with the emergence and rapid rise of resistant infections and the simultaneous drought in pharmaceutical research and development to find new therapies.  The World Health Organization WHO), the Centers for Disease Prevention and Control (CDC) and a growing number of professional societies have mounted impressive campaigns to raise awareness, educate medical practitioners, stimulate commercial investment in new drug development and pose solutions to improve stewardship of our last antibiotic arsenal.

Despite this clear consensus about what we “should” do, it’s evident that the concept is not yet firmly rooted in practice.  Not every hospital sustains a dedicated antibiotic stewardship program and most long-term care facilities lack the expertise to do so. Diagnostic testing to confirm the need for an antibiotic (or inform which antibiotic is best) is neither universally available nor used. One can visit any pediatrician’s office, parent blog site, local emergency room or primary care doctor’s office and hear varying recommendations for appropriate use of antibiotics.

The Vital Signs report from CDC called on local hospitals, clinics, long-term care facilities and public health departments to improve collaboration on infection surveillance, infection control and antibiotic stewardship.  This is an important step forward and puts all actors in a community’s system of care on notice that they are responsible (and mutually at risk) for effective stewardship.

We need to see correlating investment in stimulating and replicating rapid transformation within these communities. With millions invested in comparative effectiveness work by PCORI, it’s hard to understand why an equally large funding pool is not available for this immediate threat to our health.  Major hospitals, government agencies, foundations, pharmaceutical companies and corporate healthcare entities should emulate the collaboration they seek on the front line.  The financial investment from these sectors to establish a central resource of leadership, expert technical assistance, best practice and research would be a legacy to future generations and proof that we didn’t waste the last moments of opportunity in endless dialogue.

Changing the culture of care to deemphasize the “prescribe first” and “just in case” approach to medicine will take time. It will  challenge both provider autonomy and a patient’s sense of what is in their best interest.  It’s vital that all stakeholders look beyond immediate self-interest and join together to change attitudes and behavior, demand professional accountability, and become stewards of a precious resource before it’s too late.