Panel finds widespread inappropriate use of antibiotics in U.S. hospitals

In the United States, 77% of all UTIs and 79% of all community acquired pneumonias (CAP) are treated inappropriately in the hospital setting, according to an expert panel convened by the Pew Charitable Trust in 2018 to evaluate antibiotic use in hospitals. The panel’s findings, which were published in a March 18, 2021, report, revealed that fluoroquinolones were used inappropriately 47% of the time, and vancomycin was used inappropriately 27% of the time.

Because any amount of antibiotic can contribute to creating resistant bacteria, it is important to appropriately limit use wherever possible, the report stated. It makes sense to focus on hospital prescribing, as 60% of patients receive antibiotics during their stays.

The Pew Charitable Trust panel of experts set ambitious targets to rapidly reduce the volume of inappropriate prescribing of fluoroquinolones and vancomycin and improve prescribing of antibiotics for CAP and UTI in hospitals.

For CAP and UTI, the panel set a 90% reduction in inappropriate prescribing. The panel said that up to 10% of antibiotics that appear to be inappropriate are reasonable, given a patient’s comorbidities.

For vancomycin and fluoroquinolones, the panel recommended a 95% reduction in inappropriate prescribing. The panel said that 5% of these antibiotic orders are allowable for rare exceptions.

“The implications of these data are clear,” said Tom Dilworth, PharmD, infectious diseases clinical coordinator for Advocate Aurora Healthcare. “As a profession, we need to prioritize antibiotic stewardship in our collective practice across the continuum of care, rather than implementing novel, hypothesis-generating antibiotic therapeutic drug monitoring strategies such as vancomycin [area under the curve].”

To achieve these aggressive targets, hospitals should invest in local antibiotic stewardship programs which aim to decrease harm from antibiotic prescribing, reduce or eliminate unnecessary antibiotic use, and avoid contributing to antibiotic resistance, the panel advised. In stating that small hospitals will need technical and financial support to create these programs, the panel recognized the importance of antibiotic stewardship programs in all hospitals.

For the full article, please visit www.pharmacytoday.org for the June 2021 issue of Pharmacy Today.

Joey Sweeney, PharmD, BCPS, contributing writer