Antibiotics
Maria G. Tanzi, PharmD
New data from an observational study conducted by CDC showed that first-line antibiotics were prescribed in only 50% of visits to retail clinics, emergency departments (EDs), urgent care centers, and offices for conditions such as pharyngitis, sinusitis, and acute otitis media.1 These findings suggest that improving antibiotic selection for common conditions is an important antibiotic stewardship initiative that needs to be addressed—and pharmacists have a lead role in the initiative.
“Pharmacists are some of the most accessible health care professionals.CDC’s Office of Antibiotic Stewardship views pharmacists as key partners in the effort to improve antibiotic use,” Lauri A. Hicks, DO, study author and director of CDC’s Office of Antibiotic Stewardship, told Pharmacy Today.
CDC data
The CDC researchers used data from the 2014 IBM MarketScan commercial database to assess recommended first-line antibiotic use in both pediatric (i.e., <18 y) and adult patients (ages 18–64 y) for common conditions such as pharyngitis, sinusitis, and acute otitis media. The patients were seen in various settings, including retail clinics, EDs, urgent care centers, and offices.
In calculating the percentage of visits in which first-line antibiotics were recommended, the researchers found that amoxicillin or penicillin were recommended for pharyngitis, and amoxicillin or amoxicillin–clavulanate were recommended for sinusitis and pediatric acute otitis media.
The data showed that among antibiotic visits to retail clinics, EDs, urgent care centers, and offices for the three conditions, only 50% of patients received first-line antibiotics. These rates were higher for children than adults (62% vs. 41%) and were the highest in retail clinic settings for all three conditions across the entire cohort (70% vs. 57% in the EDs, 49% in urgent care, and 50% in offices). Macrolides were the most common non-first-line agents prescribed.
The researchers concluded that all settings could improve their antibiotic selection, as the rates should be closer to at least 80% for these three conditions. They also noted that antibiotic selection may be better in retail clinics because clinic protocols encourage guideline-concordant prescribing of antibiotics.
Pharmacists’ role
Hicks noted that when an antibiotic is prescribed, pharmacists can counsel patients and parents on how to take the antibiotic and how to discard leftover medication.
“We are also learning a lot more about the potential for adverse events associated with antibiotics, and pharmacists play an important role in educating about side effects and risks of antibiotics, as well as interactions with other medications,” Hicks said. “Patients and parents are less likely to demand or want an antibiotic if they feel that they have options to manage symptoms.”
Pharmacists can provide valuable information and recommendations for OTC medications and options for symptomatic relief. Pharmacists can also help to verify penicillin allergy by asking questions to evaluate if the patient is truly penicillin-allergic, reviewing the patient’s medication history, and discussing findings with the patient and the prescribing clinician.
Familiarizing themselves with current guidelines on appropriate antibiotic use for select conditions and discussing their use with patients and parents/caregivers is also helpful.
CDC resources
CDC’s website has a number of resources for pharmacists and other health professionals on antibiotic selection. For example, fact sheets on when antibiotics are needed and about adverse effects can be printed and provided to patients and parents (www.cdc.gov/antibiotic-use/community/for-hcp/index.html).
CDC also has symptom relief prescription pads that can be printed to provide a template for recommendations for symptomatic therapy.
Hicks said CDC is conducting in-depth interviews with pharmacists to learn about additional resources that would be useful to include on its website.
Reference:
1. Palms DL, et al. Antimicrob Agents Chemother. 2019;63(11):pii: e01060–19