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July 2020

Prescriber-led community practice changes to advance antimicrobial stewardship 1

Introduction

In Canada, over 90% of antibiotics dispensed for human use are prescribed in community settings. This paper describes a national campaign, entitled Using Antibiotics Wisely, developed to promote antimicrobial stewardship among community prescribers. Prescriber-led practice changes were formulated to support more appropriate use of antibiotics for respiratory tract infection (RTI) in primary care and urinary tract infection (UTI) in long-term care – two areas associated with high rates of inappropriate antibiotic prescribing.

Key points

  • Enabling practice change
    • Engagement with prescribers is crucial to achieve meaningful changes in antibiotic prescribing.
    • The Using Antibiotics Wisely campaign engaged community-based prescribers to identify the key changes that would support more appropriate use of antibiotics and to develop practice change statements related to the management of RTI and UTI.
  • RTI in primary care
    • 30–50% of antibiotics for RTIs in the community are unnecessary.
    • Practice change statements were generated with specific guidance on how to reduce antibiotic use in primary care for eight specific syndromes. For example: 
      • antibiotic prescriptions for pneumonia should be based on a chest x-ray (not on physical examination alone);
      • antibiotics for uncomplicated pharyngitis should only be given to those positive for group A streptococcus;
      • for patients with a viral RTI, a “viral prescription pad” can be used to outline the diagnosis, symptom management and supportive therapies that do not include antibiotics.
  • UTI in long-term care homes
    • At least 50% of antibiotic prescriptions for UTIs in long-term care residents are unnecessary.
    • Wide variability in antibiotic prescribing practices in this setting has been identified, with divergent practices in urine culture orders an important driver.
    • Practise change statements were developed to address nine steps that lead to unnecessary antibiotic prescriptions.
      • Issues addressed by the statements include:
      • outdated practices such as the use of admission order sets that include periodic screening of urine cultures;
      • assessments for changes in resident health status;
      • the need to consider alternative explanations other than a UTI.
    • At present, the optimal interventions to support these practice change statements are not known.

 

Conclusions

Collaboration among community-based healthcare providers is needed to combat the overuse of antibiotics to treat RTIs and UTIs. Evidence-based practical tools for patients and physicians that target barriers to change may help improve antimicrobial stewardship in primary and long-term care settings.

Reference:

  1. Leis JA, Born KB, Ostrow O, et al. Prescriber-led practice changes that can bolster antimicrobial stewardship in community health care settings. Can Commun Dis Rep. 2020;46(1):1-5.

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