Improving Antibiotic Use: Helping Health Care Professionals Preserve Life-Saving Treatments for Tomorrow and Beyond

National and international action plans from the United States, other countries, and the World Health Organization have made it a priority to slow the emergence and spread of drug-resistant bacteria through the use of antibiotic stewardship.

That means using the right antibiotics for the right infections at the right time and in the right manner. Countries worldwide are cooperating in the global effort to fight antibiotic resistance, recognizing that proper stewardship of antibiotics—a precious resource—is essential.

Antibiotics are life-saving drugs when used appropriately. But like most medicines, they can also have downsides—in this case, resistance. With enough exposure to an antibiotic, bacteria can develop a resistance to its effects. This makes the bacteria harder to kill and infections harder to treat.

For example, Clostridium difficile, a gut infection commonly known as C-diff, is associated with prolonged use of certain broad-spectrum antibiotics. We know through previous research that when prescribers use the right antibiotic for the right amount of time, it reduces the chances that patients will develop C-diff.

It's not easy to change the prescribing habits of clinicians. Asking clinicians to change how they prescribe antibiotics may seem simple. But it's not. That's why we recently launched the AHRQ Safety Program for Improving Antibiotic Use. This national project will provide technical assistance to help clinicians and facilities on the frontlines of care improve antibiotic prescribing practices and implement effective antibiotic stewardship programs. AHRQ is funding and guiding the project, which is being led by experts from Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality and NORC at the University of Chicago.

We're now enrolling acute care hospitals that will start work in December. In the future, we'll enroll nursing homes and ambulatory care practices in cohorts with approaches tailored to those settings. (Nursing homes that want to get a head start on stewardship should check out the Nursing Home Antimicrobial Stewardship Guide that we released last fall.)

Teams participating in this project will use AHRQ's Comprehensive Unit-based Safety Program (CUSP) method to improve antibiotic use by assuring antibiotics are needed and selecting optimal antibiotic regimens, administration routes, and durations. The CUSP method combines clinical best practices with an understanding of the science of safety, improved safety culture, and an increased focus on teamwork. CUSP has already been used successfully to reduce healthcare-associated infections in hospitals and nursing homes. So we know it helps teams change the culture of how they work together and increase the odds of implementing lasting improvements to care processes.

Applying CUSP to antimicrobial stewardship is an exciting development. There's no fee to participate in this high-benefit program. Hospitals that enroll can expect to receive access to antibiotic stewardship experts for coaching and troubleshooting and can attend monthly webinars on technical and behavioral approaches to improving antibiotic prescribing.

Participants will also have access to practical tools to apply stewardship concepts, including a timeout tool, a team antibiotic review form, and educational material for patients and families. Participation can also help hospitals improve compliance with Joint Commission requirements.

Interested in learning more? Check out the project Web site or email the project team. We look forward to hearing from you!

Dr. Miller is medical officer for AHRQ's Healthcare-Associated Infections Program.