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How do we prevent antibiotic overuse? Duke researchers weigh in

The key to better health could be solved by taking a closer look at who distributes antibiotics, according to a recent Duke study. 

The study was conducted in four community hospitals across North Carolina and tested the feasibility of two strategies in lowering the rates of antibiotic overprescription, a major cause of the development of multidrug-resistant superbugs. The national implementation of these antimicrobial strategies could have wide-ranging benefits. 

“[The issue of multidrug-resistant pathogens] is extraordinarily important. The World Health Organization calls drug resistance one of the three biggest challenges in the 21st century,” said Deverick Anderson, director of the Duke Center for Antimicrobial Stewardship and Infection Prevention and lead author of the study.  

The study focused on testing the feasibility of two antimicrobial stewardship strategies recommended by the Infectious Diseases Society of America as well as conducting preauthorization and postprescription audit and review. In both strategies, pharmacists oversaw the prescription of antibiotics by community hospitals involved in the study, Anderson explained.

For the first strategy—dubbed preauthorization—doctors were required to receive approval from pharmacists in order to prescribe a certain antibiotic. In the postprescription audit and review strategy, pharmacists measured the appropriateness of the prescribed antibiotic after three days.   

Strict preauthorization proved to be an unviable strategy, so Anderson and his team opted for a modification. The modified strategy involved a pharmacist review of the antibiotic prescription following the first dose of the prescribed antibiotic.

The study was conducted between October 2014 and October 2015 in a three-stage process including 2,692 total patients.

Although the modified preauthorization interventions proved relatively ineffective in lowering antibiotic use, postprescription interventions were a “feasible and effective strategy” in generating a “downtick in antibiotic use,” Anderson said. 

Ultimately, postprescription interventions found inappropriate antibiotic use two times as often as in preauthorization interventions.  

The study mainly tested the feasibility of the two antimicrobial stewardship strategies, though future studies could potentially further examine the effectiveness of the two strategies.

“While our goal on the infection prevention side is to have zero infections, there’s no way that we’ll have zero antibiotic use. The idea is how best to optimize the antibiotics that we use,” Anderson said. 

A final takeaway from the study was that small community hospitals can still successfully implement stewardship intervention strategies, Anderson said, which could apply to the whole country.

Support for the study came from the National Institutes of Health/National Institute of Allergy and Infectious Diseases, the Centers for Disease Control and Prevention and the Agency for Healthcare Research and Quality.  

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