Pharm
Antibiotic Overuse
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Antibiotic Overuse
, Antibiotic Stewardship
See Also
Antibiotic Resistance
Epidemiology
Antibiotics are not indicated or are incorrectly used in up to 50% of cases
Adverse Effects
Antibiotics
Antibiotic Associated Diarrhea
(including
Clostridium difficile
)
Antibiotic Resistance
(e.g.
MRSA
, PRP, VRE, Carbipenem resistant
Gram Negative
s,
Gonorrhea
,
Tuberculosis
)
Life-Threatening Drug-Induced Rashes
(e.g. DRESS)
Anaphylaxis
(esp.
Penicillin
s)
Stevens-Johnson Syndrome
(esp.
Sulfonamide
s)
Tendinopathy
(
Fluoroquinolone
s)
Nephrotoxicity (e.g.
Aminoglycoside
s)
Psychosis
(
Clarithromycin
,
Ciprofloxacin
)
QT Prolongation
(
Erythromycin
,
Fluoroquinolone
s)
Prevention
Antibiotic Overuse
Education for patients for when antibiotics are inappropriate (see resources below)
Employ exam room and pharmacy posters and newsletters (see resources below)
Dispel myths
Sputum
or nasal drainage color does not indicate
Bacterial Infection
Most
Upper Respiratory Infection
s,
Bronchitis
,
Conjunctivitis
are viral
Watchful waiting is a reasonable strategy
Otitis Media
resolves without antibiotics in two thirds of cases
Contingency plan to start antibiotics for fever, night awakening,
Vomiting
Acute Sinusitis
in the first 10-14 days
Contingency plan to start antibiotics for persistent symptoms >14 days
Diverticulitis
Uncomplicated cases may be observed for 2-3 days
Shorter antibiotic courses are effective
Uncomplicated
Pyelonephritis
and
Pneumonia
antibiotic courses are now 5 days
Viral infections have effective treatments (just not antibiotics)
Nasal Saline
,
Guaifenesin
(mucinex) and
Oxymetazoline
(afrin) for sinus congestion
Albuterol
for
Acute Bronchitis
Ibuprofen
or
Tylenol
for fever and myalgias
Antibiotic allergies are often not allergies
Results in overuse of broader spectrum antibiotics
See
Penicillin Allergy
Teach patients to be astute medical consumers
Do I really need that antibiotic, doctor?
Resources
CDC: Know When Antibiotics Work
http://www.cdc.gov/getsmart/community/for-hcp/index.html
References
(2015) Presc Lett 22(9): 51-2
(2019) Presc Lett 26(12): 70
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