Internal program foils antibiotics overuse

Many hospitals and healthcare organizations do not have a program to monitor and train doctors on prescribing antibiotics. As a result, there has been a significant increase in antibiotic-resistant bacteria, prolonged antibiotic use, and "inappropriate treatment of common viral diseases," Forrest said.

In addition, overprescribing results in significant extra costs. After implementing a program to oversee antibiotic prescribing and management at the University of Maryland Medical Center, the medical center saved $11.5 million between 2001 and 2006, noted Forrest.

Forrest believes a program to monitor antibiotic prescribing and treatments is necessary. "We can evaluate physicians based on prescribing and using antibiotics appropriately. It is really important in saving money."

Necessary components of this type of program include support from hospital executives, recruitment of the right pharmacists, and a good relationship with the organization's microbiology lab. First, Forrest suggested, encourage the hospital to fund an infectious disease (ID) pharmacist. "It's the most important part of the program. It adds an extra layer of support and education," he said. ID pharmacists would review antibiotic orders, give dosing recommendations, and answer approval calls from doctors.

It is also essential to get support from the hospital or healthcare organization. "If the hospital is not going to support you, the provider is going to do what it's going to do," Forrest said.

The hospital or healthcare organization should hold physicians accountable by requiring them to undergo infectious disease and antibiotic training in order to get their credentialing, Forrest said. "If the physician is providing only 80% of what the hospital wants, he or she doesn't get credentialed," he advised.

A good relationship between the antibiotic management department and the organization's microbiology lab is also essential, Forrest went on. Antibiotic overprescribing can sometimes be prevented by working with the microbiology lab within the healthcare organization. "You know what your own local cultures are doing, and you get immediate results," Forrest explained. Unfortunately, he added, many healthcare organizations are shutting down their microbiology labs and outsourcing instead. "I'm not sure if that's a good thing."

Other considerations when developing an antibiotic management program include:

THE AUTHOR is a writer based in Orlando, Fla.