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4
September, 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.
- antibiotic prescriptions for pneumonia should be based on a chest x-ray (not on physical examination alone);
- 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- outdated practices such as the use of admission order sets that include periodic screening of urine cultures;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.
- Issues addressed by the statements include:
- 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.
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