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CDC Launches the "Get Smart: Know When Antibiotics Work" Program

Published: October 9, 2009

Presentation slide showing 'Get Smart' campaign poster
The Get Smart campaign seeks to educate the public about the proper use of antibiotics.

Once again it's that time of year when sneezing, sniffling, sore throats, and coughing affect us all and send many of us to our healthcare providers and pharmacies. What time is that, you ask? The cold and flu season. While many of us will search for ways to obtain relief from these symptoms, antibiotics are not the answer. CDC's Get Smart: Know When Antibiotics Work program (Get Smart) is educating pharmacists, healthcare providers and the general public about the importance of appropriate antibiotic use and the growing threat of antibiotic resistance.

Antibiotic Resistance: What You Don't Know Can Hurt You

Antibiotic resistance is the ability of bacteria to resist the effects of an antibiotic designed to treat infections. Every time a person takes an antibiotic, bacteria that normally live in our bodies are killed, but resistant germs may be left to grow and multiply. Repeated use of antibiotics can lead to an increase in dangerous bacteria that are difficult to treat. These are often referred to by the media as "superbugs."

Why is this important? Upper respiratory infections account for three quarters of all antibiotics prescribed by office-based physicians. Although prescribing rates for respiratory infections have decreased among office-based physicians in recent years, according to an August 2009 article in the Journal of the American Medical Association, tens of millions of antibiotics are still prescribed each year for viral conditions that do not benefit from antibiotic therapy. Providers cite diagnostic uncertainty, time pressure on providers, and patient demand and expectations as the primary reasons why antibiotics are over-prescribed. "We ask healthcare providers to prescribe antibiotics only when the patient really needs them, and for people to take antibiotics only when needed and exactly as prescribed," says Lauri Hicks, DO, medical officer and director of CDC's Get Smart: Know When Antibiotics Work campaign.

Common infections that should not be treated with antibiotics are:

  • Colds
  • Flu
  • Most coughs and bronchitis
  • Sore throats (except for those resulting from strep throat)
  • Some ear infections

When antibiotics fail to work, the consequences are longer-lasting illnesses, more doctor visits or extended hospital stays, and the need for more expensive and toxic medications. Some resistant infections can even cause death.

Decrease unnecessary prescribing

Darcia Johnson, Becky Roberts, and Lauri Hicks
The Get Smart Team: Darcia Johnson, program officer; Becky Roberts, MS, public health specialist; and Lauri Hicks, DO, medical director.

CDC's Get Smart: Know When Antibiotics Work campaign seeks to increase awareness of the importance of appropriate antibiotic use by working with state-based appropriate antibiotic use campaigns, non-profit partners, and for-profit partners.

Objectives of GSW are to:

  • Increase the knowledge of the general public and modify their attitudes and behaviors regarding appropriate antibiotic use and antibiotic resistance, including decreasing demand for antibiotics for upper respiratory infections among healthy adults and parents, and increasing adherence to prescribed antibiotics for upper respiratory infections,
  • Decrease unnecessary prescribing of antibiotics for upper respiratory infections,
  • Decrease sharing and saving of previously prescribed antibiotics, and
  • Increase adherence to healthy behaviors to prevent acquiring an upper respiratory infection.

The take-home message of the campaign is that antibiotics will not cure viral infections and that pharmacists can play an important role in educating patients about appropriate antibiotic use. "During the flu pandemic it is more important than ever to recognize that antibiotic overuse is a serious problem and a threat to everyone's health," says Hicks. "It is important that patients and parents know that antibiotics do not treat flu, and at the same time, we ask healthcare providers, as well as pharmacists, to take the time to educate patients about antibiotic overuse. To help prevent getting sick, we ask everyone to wash their hands frequently, avoid close contact with people who are sick, and keep up to date with recommended immunizations."

Get Smart Retail Pharmacy Summit

Pharmacists and retail pharmacies are a wonderful community resource to patients and can provide much-needed information about when antibiotics work and when they don't. In order to reach pharmacists and retail pharmacy chains, Get Smart hosted a retail pharmacy summit on October 1, 2009 that brought together representatives from national retail pharmacy chains, including Rite-Aid, Kroger, Giant Eagle, and Giant/Stop and Shop, as well as non-profit and advocacy organizations focusing on appropriate use and infectious disease control, and many CDC staff and other external partners. This one-day meeting featured presentations and discussions on the latest science on antibiotic use and resistance, the important role pharmacists and retail pharmacies can play in educating patients, and specific and successful strategies to enhance social responsibility as well as profitability through partnerships with the Get Smart campaign. Attendees were excited to come together to discuss this issue and the role that pharmacists and retail pharmacy chains can have in educating patients on appropriate antibiotic use. At the end of the day, attendees pledged to "Get Smart" and share information from the summit with their companies and brainstorm ways to explore future opportunities with the program.

Get Smart Campaign

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

  • Promoting adherence to appropriate prescribing guidelines among providers,
  • Decreasing demand for antibiotics for viral upper respiratory infections among healthy adults and parents of young children, and
  • Increasing adherence to prescribed antibiotics for upper respiratory infections.

The Get Smart program targets five respiratory conditions that in 1992 accounted for more than 75 percent of all office-based prescribing of antibiotics for all ages combined: otitis media, sinusitis, pharyngitis, bronchitis, and the common cold.

The primary target audience for the Get Smart campaign is healthcare providers, as they are the gatekeepers – the ones prescribing antibiotics to patients. Parents of young children and otherwise healthy adults continue to be important audiences to reach with these messages. Pharmacists can also play an important role in educating patients about appropriate use, once an antibiotic has been prescribed, and can recommend over-the-counter alternatives to antibiotics for symptomatic relief.

Campaign Activities

Get Smart Retail Pharmacy Summit
Retail pharmacists, non-profit pharmacy organizations, advocacy groups and CDC staff attended the Get Smart Retail Pharmacy Summit on October 1.

The Get Smart program is comprehensive and includes a media campaign (including a virtual press kit and materials designed for Spanish-speakers and American Indian audiences), funding and technical assistance for several state and local partners to develop, implement, and evaluate local campaigns, as well as television and radio public service announcements (PSAs) for use in local markets.

Get Smart has produced a series of health education and behavioral change materials for patients, providers and pharmacists to promote appropriate antibiotic use. These materials include brochures, posters, and question and answer fact sheets for parents. Instructional sheets and a viral/symptomatic prescription pad are also available resources for healthcare providers.

CDC, in collaboration with the American Academy of Pediatrics, members of the American Academy of Family Physicians, the Infectious Disease Society of America, and the American College of Emergency Physicians developed and distributed principles for appropriate antibiotic use for pediatric upper respiratory tract infections, and principles of appropriate antibiotic use for adult respiratory tract infections. These guidelines define appropriate prescribing and have been distributed to numerous state and local health departments, health plans, provider groups and others.

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