It is predicted that by the year 2050, mortality from antimicrobial resistance will surpass that of cancer and diabetes combined. Up to 50% of antimicrobials prescribed in hospitals and the community are considered unnecessary; inappropriate microbial usage can drive antimicrobial resistance.
On a global scale, several new “super bugs” pose an urgent threat to society, including multi-drug resistant Neiserria gonorrhea and carbapenem-resistant Enterobacteriacea. Providing antimicrobials unnecessarily also increases risk of drug toxicity, length of hospital stay, and other infections, including Clostridium difficile infection.
Promoting judicious use of antibiotics is a critical strategy in the fight against antimicrobial resistance. Antibiotic Wisely is a campaign from Choosing Wisely Canada. There are more than 20 Choosing Wisely Canada recommendations that encourage judicious antibiotic use.
Dr. Shaqil Peermohamed is a Saskatchewan infectious diseases specialist championing the wise use of antibiotics. As physician lead for Saskatoon Health Region’s Antimicrobial Stewardship Team and a participant in the first wave of the province’s new Clinical Quality Improvement Program (CQIP), Dr. Peermohamed is assessing the impact of antimicrobial stewardship rounds in Royal University Hospital’s intensive care unit on antimicrobial usage and a variety of patient-centred outcomes.
We caught up with Dr. Peermohamed on the eve of Antibiotics Awareness Week (November 13-19, 2017). Here, here he shares his thoughts on the key role both physicians AND patients play in using antibiotics wisely.
Q: What are some of the most common ways that antibiotics are being overused?
A: Overuse in both the community and in hospitals is often related to providing therapy that is too broad, too long of a duration, or in some cases, not indicated. Antibiotics are often being prescribed for positive culture results that represent colonization or contamination, and not true infection. We also see overprescribing of antimicrobials for syndromes that are predominantly caused by viruses, such as bronchitis or sinusitis.
Q: What can health care providers do to reduce this overuse?
A: Patients entrust us as health care providers to provide a high standard of appropriate care; we should make a pledge and commitment to provide them with the right antibiotic if needed. At its core, antimicrobial stewardship is a patient-centred, quality improvement initiative. As health care providers, we should strive to prescribe antimicrobials carefully and responsibly. It is essential that we provide the right antimicrobials to patients, but only when they need them.
Q: What can patients do?
A: Improving the use of antibiotics is a critical patient safety issue. Antibiotics may not always be the answer and patients should feel comfortable asking their health care providers if antibiotics are needed or not. There is emerging evidence that many common infections such as pneumonia and cellulitis can be effectively treated with shorter durations of treatment. In fact, prescribing antimicrobials for longer than a patient has symptoms can actually do more harm than good. Thus, patients should ask their doctor if they can stop antibiotic treatment early if their symptoms have resolved.
Q: Any closing thoughts?
A: Antibiotics can be life-saving drugs when used properly. In an era of antimicrobial resistance and a paucity of new antimicrobials in the drug pipeline, we must use these precious resources wisely. Everyone, including both patients and health care providers, can play a key role as champions of antimicrobial stewardship.