Antibiotic stewardship program imminent

In an unusual move, the Obama administration has put the force of the

behind a push to preserve the power of antibiotics, including plans for wide-ranging impact on healthcare.

The

, released by the White House in March, calls for a reduction in inappropriate antibiotic use by half in outpatient settings and by 20% in inpatient settings by 2020.

The plan also calls for annual reporting of antibiotic use in both inpatient and outpatient settings to identify geographic areas and providers for interventions.

It requires federal agencies and others to propose expanded quality measures for antibiotic prescribing. Among other actions, within 3 years, the Centers for Medicare and Medicaid Services plans to expand the Physician Quality Reporting System to discourage “inappropriate antibiotic use to treat nonbacterial infections, such as respiratory tract infections.”

Federal agencies are to propose rules within the next year to require hospitals, ambulatory surgery centers, dialysis centers, and other inpatient facilities to “implement robust antibiotic stewardship programs” and activities that align with the Centers for Disease Control and Prevention (CDC) “Core Elements of Hospital Antibiotic Stewardship Programs.”

The CDC is to support health departments in creating state antibiotic stewardship and appropriate antibiotic use programs that will identify healthcare facilities with high antibiotic prescribing rates, move to improve those rates, and track the results.

By 2020, stewardship programs are to be established in all acute care hospitals, along with “improved” stewardship in all healthcare settings. Also within 3 years new or revised federal “conditions of participation” for hospitals that accept Medicare and Medicaid will require compliance with CDC’s “Core Elements.”

The plan also calls for advancing rapid diagnostic tests for identification and characterization of resistant bacteria, as well as for distinguishing between viral and bacterial pathogens; accelerating research on antibiotics, vaccines and other therapeutics; and improving international collaboration on antibiotic resistance.

It focuses specifically on resistance in bacteria considered to be an urgent or serious threat, rather than targeting all dangerous pathogens that might develop resistance.

Eyes on the prize

Sameer Patel, MD, MPH, medical director of the Antimicrobial Stewardship Program at the Anne and Robert H. Lurie Children’s Hospital of Chicago, Illinois, calls the plan, “an excellent first step for sure.”

It’s timely, he says, because there is now a lot of government, industry, academic, and healthcare interest in the issue.

Among the plan’s advantages, he says, is its focus on surveillance efforts to understand resistance and its push for development of diagnostic tests to allow prescribers to decide if an antibiotic is needed and to choose the right one faster.

There is always an adjustment for healthcare professionals in beginning to report data, he says, “but ultimately it is going to be very important for patient care,” similar to the importance of reporting of hospital associated infections.

Antibiotic stewardship programs are becoming more common, says Patel, but they come in different flavors. They can range from a requirement to get permission to use certain antibiotics from a pharmacy, to educational programs to help clinicians treat certain conditions, and to report cards on antibiotic use.

Five or 6 years ago, antibiotic stewardship in pediatrics was commonly found only in big pediatric hospitals, Patel says. However, it’s become the norm in children’s hospitals in academic centers. It’s also become more common in other large children’s hospitals, and smaller community hospitals are starting some activities, he indicates.

Edward Bell, PharmD, of Blank Children’s Hospital and Clinics in Des Moines, Iowa, agrees with Patel’s opinion that the White House plan could have given more emphasis to reducing antibiotics in agricultural animals to promote growth. The plan does call for eliminating the use of medically important antibiotics for that use and for bringing other agricultural uses of antibiotics under veterinary oversight.

Estimates, including those from the Natural Resources Defense Council, say that the majority of antibiotics used in this country are used in animals, and most of those are used to make food animals grow faster.

Ms Foxhall is a freelance writer in the Washington, DC, area. She has nothing to disclose in regard to affiliations with or financial interests in any organizations that might have an interest in any part of this article.