In a Vital Signs report the CDC endorsed the initiation of Antibiotic Stewardship Programs for hospitals in an effort to guard against increasingly prevalent and troublesome prescribing practices by physicians. In particular, the CDC report argued that increasing and unwarranted antibiotic prescriptions can expose patients to higher risks of allergic reactions, super-resistant infections, and deadly diarrhea, and in general can contribute to antibiotic resistance. This CDC report follows other notable developments regarding newly-released information on treating antibiotic-causing infections as well as the inclusion of the antibiotic resistance campaigns in the 2015 health budget recently proposed by the Obama Administration.
CDC Findings and Recommendations
The CDC framed its Vital Stats report entitled “Antibiotic Rx in Hospitals: Proceed with Caution,” using these noteworthy figures: (1) more than half of all hospital patients receive an antibiotic; (2) certain doctors in certain hospitals have been found to prescribe three times as many antibiotics as doctors in other hospitals; and (3) the reduction of antibiotic prescribing by 30 percent will, in turn, reduce the existence of Clostridium difficile infection (C. diff), otherwise known as deadly diarrhea, by 26 percent. Specifically, the CDC identifies several poor prescribing practices including error—such as that one in three attempts to use the drug vancomycin to treat urinary tract infections included discrepancies in testing, evaluation, or time of administration—and wide variation in prescribing, which according to the CDC calls for improvement. The CDC also cites to various reasons as to why poor antibiotic prescribing is problematic including the increased susceptibility to C.diff and higher likelihood of contracting other, more resistant infections due to the ingestion of infection-treating antibiotics.
Due to these issues, the CDC recommends the adoption of Antibiotic Stewardship Programs in hospitals, through the creation and execution of a checklist, which would include (at a minimum):
- A commitment to dedicate human, financial, and IT resources to create and administer the program;
- Appointment of a single leader responsible for program outcomes;
- Appointment of single pharmacist leader to support improvements in prescribing practices;
- The execution of at least one prescribing improvement action;
- The tracking of prescribing and antibiotic resistance;
- The reporting of those patterns to staff; and
- The availability of educational resources on prescribing practices and antibiotic resistance.
The CDC expands on this initiative with respect to specific roles for state and local departments, hospital CEOS or medical officers, physicians and other hospital staff, and patients on its website. Additionally, the American Academy of Pediatrics endorsed the CDC’s recommendations and published additional information on the role of pediatricians in combating poor antibiotic prescription patterns.
C. diff Developments
The CDC report estimates that deadly diarrhea caused by C. diff leads to over 250,000 infections and 14,000 deaths each year and decreasing antibiotic use would result in a 26 percent reduction of those infections. These reported numbers follow a recent draft guidance issued by the FDA which authorizes the use of fecal microbiota for transplantation (FMT) to treat C. diff in certain circumstances. Specifically, in this guidance the FDA clarified that FMT treatment should be limited to situations in which the infection has not responded to standard therapies and samples should only be collected from individuals known to patients or providers.
Antibiotics Resistance Initiatives in 2015 Proposed Budget
This report was also released on the same day as the release of the Obama Administration’s 2015 proposed budget. This budget dedicates over $77.1 billion to HHS for discretionary spending and explicitly provides for a $30 million budget increase to contribute to the CDC’s “Detect and Protect Against Antibiotic Resistance” initiative. Additionally, the proposed budget will devote $29 million to the FDA for advancement of “integrated monitoring of antimicrobial resistance.” Finally, the HHS budget acknowledges the anticipated spending of $79 million by the Biomedical Advanced Research and Development Authority in 2015 for its Broad Spectrum Antimicrobials program.