Ambulatory Care- Antibiotic Stewardship Programs (ASP) In the Indian Health Service CDR Robin Bartlett, PharmD, MSP, CPC October 22, 2015 1 Objectives • Understand the affects of antibiotic overprescribing in the ambulatory/outpatient setting • Adverse events related to antibiotics • The concept of collateral damage, the ramifications of resistant organisms and their economic burden • Review the Core Principles of ASP and the implementation of ASP in the ambulatory setting • Identify Examples & Unique Opportunities of ASP 2 High Rates of Antibiotic Prescribing http://www.cdc.gov/getsmart/community/materials-references/graphics.html 3 Overuse of Antibiotics in the Ambulatory Setting • When looking at costs, the majority of antibiotic prescribing is in the community setting Suda, et al. J Antimicrob Chemotherapy 2013;68:715-18 4 Antibiotic Overprescribing • Between 20-50% of antibiotic prescriptions are either unnecessary or inappropriate • Lack of indication (bronchitis, viral infection, etc) • Inappropriate use of broad spectrum antibiotics • Inappropriate antibiotic choice (for the pathogen or site of infection) • Excessive length of therapy • Dosing not optimized • Antibiotics are responsible for almost 1 out of every 5 Emergency Department visits for drug-related adverse events Fishman N. Am J Med. 2006 Jun;119(6 Suppl 1):S53-61 Shehab, etal. Clin Infect Dis. 2008;47(6):735-43 5 Antibiotic Prescribing by Condition, US adults 2007-2009 Shapiro, et al. J Antimicrob Chemother doi:10.1093/jac/dkt301 2013 6 Some Reasons for Antibiotic Overprescribing • Doctors may prescribe antibiotics before receiving test results that identify the actual cause of infection • People who want quick relief from symptoms (i.e. viral infections) may pressure doctors for antibiotic prescriptions • People may take antibiotics purchased abroad or from other family members for self-diagnosed illnesses • People may take antibiotics leftover from a prior prescription 7 Collateral Damage • Antibiotics are unique- When they are used by one person it affects the whole population by alteration of the microbial ecology! 8 Consequences of Antibiotic Use http://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf 9 How Resistance Happens Patel G et al. Infect Control Hosp Epidemiol 2008;29:1099-1106 Zaoutis TE et al. Pediatrics 2005;114:942-9 10