Path Toward Good Antibiotic Stewardship

Apr 5, 2018
Overuse or inappropriate use of antibiotic medications poses a serious threat of antimicrobial resistance.
Rph Article

Antibiotics have been one of the most important discoveries of the 20th century. Indeed, they are indispensable not only in treating everyday bacterial infections, but also helping save millions of lives and controlling the spread of infectious diseases. However, the overuse or inappropriate use of these medications poses a serious threat of antimicrobial resistance. Despite public health initiatives to raise awareness and reduce unnecessary antibiotics prescriptions, healthcare providers continue to prescribe these medications at high rates.

Over the past two years, Express Scripts has partnered with Washington University and the Centers for Disease Control and Prevention (CDC) to examine the use of antibiotics to better understand antibiotic prescribing patterns and identify ways to improve appropriateness use, thereby eliminating waste and potential harm to patients.

Antibiotic Use Not Declining

New research published in the Journal of Infection Control and Hospital Epidemiology examined nearly 98 million antibiotic prescriptions over a three-year period between 2013 and 2015. The study found that overall antibiotic prescription use did not decline during this period, despite efforts to better educate prescribers and patients about overuse of antibiotics.

We did observe seasonal peaks in antibiotic prescribing, with higher usage for certain antibiotics in the winter months. Antibiotics frequently associated with management of upper respiratory tract infections, such as azithromycin, were the ones prescribed at higher rates during the winter months, which coincide with the flu season. These trends may indicate unnecessary use of antibiotics to treat viral infections, for which they are not effective.

Antibiotics are not expensive, costing only $23 per year per beneficiary according to the study. However, the total amount spent by insurers and patients on these drugs was nearly $1 billion annually. According to the CDC, 30% of antibiotics prescribed are unnecessary, which indicates that millions of dollars are wasted each year on inappropriate antibiotic use. The medical consequences of antibiotic overuse are more significant and can lead to unnecessary hospitalizations and other medical care, and potential harm to patients, which adds further economic burden on payers and the health care system.

Turning research into action

Building on this and other published research resulting from our partnership that found dentists prescribing large quantities of antibiotics for prolonged durations, we are focused on turning our research insights into action.

Our previous study evaluating dental antibiotic prescribing practices that was published in the Journal of the American Dental Association has gained the attention of the American Dental Association (ADA). Dr. Michael Durkin, our research partner at Washington University, will be participating on an expert panel convened by the ADA to define the scope, purpose, target audience and clinical questions for the 2018 Antibiotic Therapeutics Clinical Practice Guideline.

Additionally, we have had preliminary discussions with the Minnesota Department of Health to examine clostridium difficile infections and pilot test an antibiotic stewardship program – a quality improvement project to improve appropriate prescribing in outpatient settings.

We continue to work with Dr. Durkin and the CDC to conduct further studies to identify and understand the gap between current antibiotic prescribing practices in the community and clinical practice guidelines, with the goal of substantially improving outpatient antibiotic prescribing.

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