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About the Get Smart Campaign

Why CDC has an appropriate antibiotic use campaign

Antimicrobial resistance among respiratory pathogens has become a common clinical problem, and the association of resistance with the use of antimicrobial drugs is well documented in both inpatient and outpatient settings.

The Institute of Medicine has identified antibiotic resistance as one of the key threats to health in the United States and has listed decreasing the inappropriate use of antimicrobials as a primary solution to address this threat. For this reason, antibiotic resistance is among CDC's top concerns.

Campaign objectives

CDC launched the National Campaign for Appropriate Antibiotic Use in the Community in 1995. In 2003, this program was renamed Get Smart: Know When Antibiotics Work in conjunction with the launch of a national media campaign. This campaign aims to reduce the rate of rise of antibiotic resistance by:

  1. promoting adherence to appropriate prescribing guidelines among providers,
  2. decreasing demand for antibiotics among both healthy adults and parents of young children, and
  3. increasing adherence to prescribed antibiotics.

Focus on upper respiratory infections

Upper respiratory infections account for three quarters of all antibiotics prescribed by office-based physicians, and antibiotics are often used inappropriately. Even though prescribing rates have decreased, current data suggest that for all ages combined more than ten million courses of antibiotics are prescribed each year for viral conditions that do not benefit from antibiotics.

The Get Smart campaign primarily targets five respiratory conditions that account for more than 75% of all office-based prescribing for all ages combined: otitis media, sinusitis, pharyngitis, bronchitis, and the common cold.

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Target audiences of the campaign

The target audiences for this campaign include patients and providers since knowledge, attitudes, and behaviors of both contribute to antibiotic prescribing and antibiotic use. Antibiotic prescribing is highest for young children, therefore the primary audiences are parents of young children and their primary care providers. Otherwise healthy adults under 50 years of age and their primary care providers are additional target audiences.

Campaign activities

Developing and distributing health education materials

CDC produced a series of health education and behavioral change materials for both patients and providers to promote appropriate antibiotic use. These include brochures, posters, fact sheets, instructional sheets for small group physician education, prescription adherence sheets, and viral/symptomatic prescription pads. The prescription pad in particular has been extremely popular and useful as a communication tool. Healthcare providers can use these tools to recommend strategies for symptomatic relief of illnesses, acknowledge and address the patient's discomfort, and suggest alternative solutions without prescribing an antibiotic unnecessarily.

Establishing principles for appropriate antibiotic use by healthcare providers

One of the ongoing products of CDC's campaign is the development and distribution of principles for appropriate antibiotic use for pediatric upper respiratory tract infections. These guidelines were developed in collaboration with the American Academy of Pediatrics and members of the American Academy of Family Physicians.

CDC has also collaborated with members of the American Academy of Family Physicians, American College of Physicians, Infectious Disease Society of America, and the America College of Emergency Physicians to develop principles of appropriate antibiotic use for adult respiratory tract infections. The pediatric and adult guidelines provide a definition of appropriate prescribing and have been distributed to numerous state and local health departments, health plans, physician groups and others.

Implementing a national media campaign

CDC developed a national media campaign in partnership with the Food and Drug Administration (FDA) to provide a coordinated message on appropriate antibiotic use and create a foundation for local efforts across the country. Using the tagline Get Smart: Know When Antibiotics Work, the campaign was launched on September 17, 2003 and has since been disseminated through print, television, radio and outdoor media (virtual press kit). These materials and media toolkits were distributed to CDC-funded sites for use in conjunction with their local campaigns. They included materials for healthy adults (ages 18-50 years), Spanish speakers, and American Indians/Alaska Natives. Although media toolkits are no longer distributed, the campaign coordinates Get Smart About Antibiotics Week annually as a way to generate media interest and engage partners.

Providing assistance to develop, implement, and evaluate local appropriate antibiotic use campaigns

CDC distributes federal funds to state and local health departments for the development, implementation, and evaluation of local campaigns to promote appropriate antibiotic use. View map of funded sites. Technical assistance to support these funded sites includes: identifying resources, sharing new scientific and educational information, facilitating networking and the formation of partnerships, and conducting monthly phone calls to track progress and identify program needs.

Get Smart About Antibiotics Week

Starting in 2008, the campaign coordinated its first national observance, Get Smart About Antibiotics Week. Get Smart About Antibiotics Week 2008 was the first effort to coordinate the work of CDC’s Get Smart: Know When Antibiotics Work campaign, state-based appropriate antibiotic use campaigns, non-profit partners, and for-profit partners during a one week observance of antibiotic resistance and the importance of appropriate antibiotic use. Through a variety of activities and resources, the messages of the Get Smart campaign are delivered every year.

Developing and testing Healthcare Effectiveness Data and Information Set (HEDIS®) performance measures

CDC and the National Committee on Quality Assurance have written two pediatric and two adult Healthcare Effectiveness Data and Information Set (HEDIS®) measures.

HEDIS® is a performance measurement tool used by over 90 percent of the nation's health plans. Experts in appropriate antibiotic use collaborated with a multidisciplinary team of researchers with expertise in the development and testing of HEDIS® measures to develop these measures. The pediatric measures, which were incorporated into HEDIS® in 2004, are:

  1. Appropriate testing for children with pharyngitis: percentage of children 2 to 18 years of age who were diagnosed with pharyngitis, prescribed an antibiotic and received a group A streptococcus (strep) test for the episode.
  2. Appropriate treatment for children with upper respiratory infection (URI): percent of children 3 months to 18 years of age with a diagnosis of URI who were not prescribed antibiotics on or three days after the episode date.

The adult measures, which were incorporated into HEDIS® in 2006 and 2008, respectively, are:

  1. Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis (inverted the measure rate and renamed measure for 2008). Adults diagnosed with acute bronchitis who were not dispensed an antibiotic prescription.
  2. Antibiotic Utilization: This measure summarizes data on outpatient utilization of drug prescriptions, stratified by age.

    This measure evaluates many factors, including total number of antibiotic prescriptions, average number of prescriptions per year, and use of antibiotics of concern.

Securing funding for and promoting the adoption of provider curricula

CDC developed an appropriate antibiotic use curriculum for medical students in collaboration with Westat and the University of California, San Diego. The curriculum has been reviewed, updated, and piloted by Wake Forest University School of Medicine. The curriculum was made available to all U.S. medical schools for the 2010-2011 academic year.

View more continuing education opportunities.

Campaign staff

The Get Smart campaign is headed by a Medical Director. Health educators and communication specialists develop, implement, and evaluate national campaign activities while also providing technical assistance to local campaigns in funded states and counties. If you are interested in contacting the staff, please e-mail getsmart@cdc.gov.

Getting involved in the campaign

There are many partners that support the campaign in a variety of ways, including promoting Get Smart About Antibiotics Week. Please visit our Partners page to learn more.

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