We will conclude this week with a helpful list of tips from our own ID stewardship experts. Thanks to Dr. Lee, Dr. Cutrell and Dr. Bhavan!
Antibiotics are a precious but finite resource in medicine. The best way to preserve them for future patients is optimizing antibiotic utilization now.
Ways to use antibiotics wisely include:
- Avoid antibiotics when not needed
- Use the narrowest agent possible
- Ensure the right dose and right route of administration
- Use the shortest duration of therapy needed
- Promote antibiotic best practices including an “antibiotic timeout”
Key questions to ask when starting or reassessing antibiotics:
- Does my patient really have an infection?
- Don’t forget to consider non-infectious causes of fever or elevated WBC.
- Can I target my therapy for a particular pathogen?
- Use narrow spectrum agents to target positive culture results.
- If no culture data available, the lack of patient risk factors for drug-resistant pathogens (like MRSA or Pseudomonas) may allow safe de-escalation to narrower agents.
- Are there patient factors that impact antibiotic dosing?
- Changes in renal or hepatic function
- Drug-drug interactions, esp. with oral abx that may impair absorption
- Don’t hesitate to contact your pharmacist or stewardship team for help!
- How long do I need to treat this infection?
- Practice guidelines from IDSA and others may help guide duration of treatment for common infections (http://www.idsociety.org/IDSA_Practice_Guidelines/)
As always, the Antimicrobial Stewardship Programs at each hospital are available to help with these questions, so please contact us at any time.
Kavita Bhavan- Parkland
Brad Cutrell- VA
Francesca Lee- UTSW