According to the CDC’s Morbidity and Mortality Weekly Report, antibiotic prescribing for inpatients is common but offers few benefits and could expose patients to risks for complications like Clostridium difficile (CDI) if prescribed incorrectly.

Scott Fridkin, MD, and colleagues evaluated data from the MarketScan Hospital Drug Database and CDC’s Emerging Infections Program (EIP) for the extent and rationale in antibiotic prescribing, possible improvements in prescribing methods, and estimates of reductions in CDI with proper antibiotic prescribing. From the MarketScan data of 323 hospitals, 55.7% of hospitalized patients were administered an antibiotic, with 29.8% receiving at least 1 dose of broad-spectrum antibiotics.

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The EIP evaluation showed that across 183 hospitals, about half (49.9%) of all treatment antibiotics were prescribed in one or more of three scenarios: lower respiratory infections, UTIs, or presumed resistant Gram-positive infections. The team estimated that in 37.2% of cases of prescribed antibiotics, improvements could have been made via improved diagnostic testing in two specific scenarios: UTIs in patients without indwelling catheters and treatment with IV vancomycin.

With a 30% decrease in the prescribing of broad-spectrum antibiotics, it is estimated that the incidence of CDI will be reduced by 26%. The authors note that while correct antibiotic treatment is essential for some patients, stewardship programs are needed to address issues of antibiotic resistance and reduce potential patient harm. The CDC recommends that antibiotic stewardship programs include a minimum of seven core elements:

  • Leadership support
  • Accountability through a single physician lead
  • Drug expertise through a single pharmacy lead
  • Action including at least one intervention, such as an “antibiotic timeout,” to improve prescribing
  • Tracking prescribing and resistance patterns
  • Reporting local prescribing and resistance information directly to clinicians
  • Education for clinicians

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