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Anti-antibiotics

Anti-antibiotics In their excellent Review Article on the principles of conservative prescribing, Schiff et al1 make only infrequent specific reference to antibiotics. Yet herein lies great opportunity for more judicious prescribing, the importance of which is punctuated by the multiple-drug–resistant organism and Clostridium difficile epidemics, the “collateral damage” of antibiotics. Because antibiotics are relatively so efficacious, safe, and inexpensive, they are prone to overuse. Inconsiderable attention has been given to when to withhold antibiotics and when to discontinue them once in use. Antibiotic stewardship programs address judicious use,2 and we recently reviewed specific guidelines for limiting antibiotic use.3 In our review, we cited common infections and situations when antibiotics should be withheld in the first place, including viral respiratory syndromes, selected cases of otitis media, asymptomatic bacteriuria in both noncatheterized and catheterized patients, selected cases of skin and soft-tissue infections, and “low-grade fever.”3 Also, the traditionally accepted duration of antibiotics should be shortened for such common infections as acute exacerbations of chronic bronchitis, pneumonias, urinary tract infections, intra-abdominal infections, and Staphylococcal aureus bacteremia, as well as for surgical prophylaxis.3 While acknowledging that we need more and better data, we suggest that regulatory agencies already begin enforcing existing guidelines for the withholding and withdrawing of antibiotics, to confront the multiple-drug–resistant organism and C difficile epidemics, as the Centers for Medicare & Medicaid Services has done for surgical antibiotic prophylaxis.4 Back to top Article Information Correspondence: Dr Wlodaver, M.D. Medical Tower, 8121 National Ave, Ste 310, Midwest City, OK 73110 (cliff_wlodaver@yahoo.com). Financial Disclosure: None reported. References 1. Schiff GD, Galanter WL, Duhig J, Lodolce AE, Koronkowski MJ, Lambert BL. Principles of conservative prescribing. Arch Intern Med. 2011;171(16):1433-144021670331PubMedGoogle ScholarCrossref 2. Dellit TH, Owens RC, McGowan JE Jr, et al; Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159-17717173212PubMedGoogle ScholarCrossref 3. Wlodaver CG, May C. Antibiotic Stewardship: using clinical guidelines to control antibiotic overuse and deter microbial adaptation [published online October 27, 2011]. Infect Dis Clin PractGoogle Scholar 4. Centers for Medicare & Medicaid Services. Hospital inpatient quality reporting program. http://www.cms.gov/HospitalQualityInits/08_HospitalRHQDAPU.asp. Accessed May 23, 2011 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

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References (4)

Publisher
American Medical Association
Copyright
Copyright © 2012 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinternmed.2011.758
Publisher site
See Article on Publisher Site

Abstract

In their excellent Review Article on the principles of conservative prescribing, Schiff et al1 make only infrequent specific reference to antibiotics. Yet herein lies great opportunity for more judicious prescribing, the importance of which is punctuated by the multiple-drug–resistant organism and Clostridium difficile epidemics, the “collateral damage” of antibiotics. Because antibiotics are relatively so efficacious, safe, and inexpensive, they are prone to overuse. Inconsiderable attention has been given to when to withhold antibiotics and when to discontinue them once in use. Antibiotic stewardship programs address judicious use,2 and we recently reviewed specific guidelines for limiting antibiotic use.3 In our review, we cited common infections and situations when antibiotics should be withheld in the first place, including viral respiratory syndromes, selected cases of otitis media, asymptomatic bacteriuria in both noncatheterized and catheterized patients, selected cases of skin and soft-tissue infections, and “low-grade fever.”3 Also, the traditionally accepted duration of antibiotics should be shortened for such common infections as acute exacerbations of chronic bronchitis, pneumonias, urinary tract infections, intra-abdominal infections, and Staphylococcal aureus bacteremia, as well as for surgical prophylaxis.3 While acknowledging that we need more and better data, we suggest that regulatory agencies already begin enforcing existing guidelines for the withholding and withdrawing of antibiotics, to confront the multiple-drug–resistant organism and C difficile epidemics, as the Centers for Medicare & Medicaid Services has done for surgical antibiotic prophylaxis.4 Back to top Article Information Correspondence: Dr Wlodaver, M.D. Medical Tower, 8121 National Ave, Ste 310, Midwest City, OK 73110 (cliff_wlodaver@yahoo.com). Financial Disclosure: None reported. References 1. Schiff GD, Galanter WL, Duhig J, Lodolce AE, Koronkowski MJ, Lambert BL. Principles of conservative prescribing. Arch Intern Med. 2011;171(16):1433-144021670331PubMedGoogle ScholarCrossref 2. Dellit TH, Owens RC, McGowan JE Jr, et al; Infectious Diseases Society of America; Society for Healthcare Epidemiology of America. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis. 2007;44(2):159-17717173212PubMedGoogle ScholarCrossref 3. Wlodaver CG, May C. Antibiotic Stewardship: using clinical guidelines to control antibiotic overuse and deter microbial adaptation [published online October 27, 2011]. Infect Dis Clin PractGoogle Scholar 4. Centers for Medicare & Medicaid Services. Hospital inpatient quality reporting program. http://www.cms.gov/HospitalQualityInits/08_HospitalRHQDAPU.asp. Accessed May 23, 2011

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Feb 13, 2012

Keywords: antibiotics

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