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Study examines ways to limit excessive, unnecessary antibiotic use

By Jamie Lampros - Special to the Standard-Examiner | May 13, 2023

Harrison Epstein, Daily Herald

Bottles of antibiotics sit in the Blake Family Medicine clinic in Provo on Wednesday, March 8, 2023.

A new study led by researchers at Intermountain Health and University of Utah Health found overuse of antibiotic medications can be cut by use of better prescription practices.

“Antibiotic stewardship can be done, and well done,” said Dr. Edward Stenehjem, an infectious disease specialist at Intermountain Health and one of the leading researchers in the study. “That’s especially true for urgent care centers that are integrated into health care systems. These results show the role we can play in reducing prescribing rates in these critical and unique care settings, which is better for patients and our community overall.”

By using antibiotic stewardship initiatives specially designed for outpatient settings, researchers were able to reduce prescribing rates by 15% at urgent care clinics. That amounts to millions of antibiotic doses. Antibiotic overuse or misuse promotes bacteria-resistant infections.

The stewardship included educating patients and health care providers, providing transparent data to clinicians on how their antibiotic prescribing compared to their peers, and using a communications campaign and signage to ensure patients were aware of efforts being made to improve their health.

“This study shows a health system approach to reducing unnecessary antibiotic prescriptions for a large population that is both safe and acceptable for patients and clinicians,” said Dr. Adam Hersh, pediatric infectious disease physician at U of U Health and a lead researcher in the study. “It’s important to note that these benefits have been sustained even after the study ended, indicating that the effects of antibiotic stewardship can be durable over time.”

For the study, Intermountain Health researchers created an urgent care-specific antimicrobial stewardship program for 38 different urgent care facilities in Utah, including 32 for patients of all ages. Six of those clinics were for children 18 and younger.

Researchers tracked the amount of antibiotics prescribed for respiratory infections, including sore throat, bronchitis and sinusitis. Respiratory illnesses are the most common reasons patients go to urgent care and receive high rates of inappropriate antibiotic prescriptions, according to Stenehjem.

From July 1, 2018, to June 30, 2019, antibiotics were prescribed for 48% of respiratory infections at these urgent care clinics. That was before the study kicked in. During the study, from July 1, 2019, to June 30, 2020, prescriptions dropped to 33%.

“The results emphasize the importance of health systems, including urgent care clinics, as part of antibiotic stewardship solutions,” Stenehjem said. “This isn’t one clinic. This isn’t two clinics. This is 38 clinics. When you think about the impact this has on one community, this is a huge difference. It’s millions of doses of unnecessary antibiotics avoided.”

The study, funded by the Centers for Disease Control and Prevention, was published Thursday in the Journal of American Medical Association Network Open.

“This study provides an excellent model for what can be done to improve antibiotic prescribing in urgent care,” said Dr. Lauri Hicks, director of the CDC’s office of antibiotic stewardship. “We encourage other health care systems and health care professionals to consider implementing these approaches in their urgent care practices. It will go a long way toward optimizing patient safety and combating antibiotic resistance.”


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