Improve Antibiotic Use

The preventive healthcare-associated infections evidence summary.

Fast Facts
  • Each year in the U.S., at least 2 million people are infected with antibiotic-resistant bacteria and about 23,000 people die as a result.
  • Antibiotic resistant infections can cost $20 billion in direct healthcare costs. Additional costs from lost productivity may be as high as $35 billion per year.
  • Many prescribed antibiotics are inappropriate or unnecessary, including:
    • 20-50% of antibiotics prescribed in hospitals are inappropriate or unnecessary.
    • 40-75% of antibiotics prescribed in nursing homes are inappropriate or unnecessary.
    • 30% of antibiotics prescribed in doctor’s offices and emergency departments are unnecessary.
Evidence-Based Interventions

Inpatient and nursing home intervention:

  1. Require antibiotic stewardship programs in all hospitals and skilled nursing facilities, in alignment with CDC’s Core Elements of Hospital Antibiotic Stewardship Programs and The Core Elements of Antibiotic Stewardship for Nursing Homes.

 Outpatient intervention:

  1. Improve outpatient antibiotic prescribing by incentivizing providers to follow CDC’s Core Elements of Outpatient Antibiotic Stewardship. Specific examples can include:
    • Audit and feedback of provider antibiotic prescribing practices with comparisons to their peers.
    • Public commitment posters.
    • Communication training for providers to give them strategies to effectively communicate with patients about antibiotics.

What You Could Do to Improve Antibiotic Use

Healthcare Providers

  • Participate in the Merit-Based Incentive Payment Systemexternal icon (MIPS) where you can receive performance-based payment adjustments on antibiotic quality measures and improvement activities.
  • Improve outpatient antibiotic prescribing by using CDC’s Core Elements of Outpatient Antibiotic Stewardship within your practice. For example:

Payers

  • Perform audit-and-feedback by sharing data with healthcare providers on the provider’s own antibiotic prescribing practices, particularly on quality measure performance, compared to their peers.
  • Incentivize providers to participate in continuing medical education and use quality improvement practices about appropriate antibiotic prescribing offered by professional societies, public health agencies, and other groups.
  • Include payment strategies for improved antibiotic use in healthcare provider and facility contracts.

Employers

  • Consider participating in organizations that examine doctors and hospitals based upon quality care measures, including appropriate prescribing practices for antibiotics.
  • Talk with your health plan to incorporate payment strategies for improved antibiotic use into provider contracts.
  • Encourage your insurance carrier to work with healthcare facilities or physicians that have antibiotic stewardship programs or have good prescribing practices in their organizations.

Selected Studies Behind the Interventions

Antibiotic Stewardship Programs

Antibiotic stewardship is the effort to measure and improve how providers prescribe and patients use antibiotics. Improving antibiotic use through antibiotic stewardship can lead to decreased antibiotic resistance and prevent avoidable antibiotic adverse events, such as allergic reactions and Clostridioides difficile infections, a sometimes-deadly diarrheal infection.

Hospital Antibiotic Stewardship

The University of Maryland teaching hospital started an antibiotic stewardship program led by a physician and pharmacist. After carrying out the program, antibiotic use costs decreased from $44,181 to $23,933 in 2007 per 1,000 patient days in the hospital (patient days). The hospital stopped the antibiotic stewardship program in 2008 in order to hire more infectious disease physicians. As a result, antibiotic use costs increased to $31,653 per 1,000 patient days within two years. This study concluded that the antibiotic stewardship program provided significant cost savings to the hospital over seven years.1

Nursing Home Antibiotic Stewardship

A study evaluating antibiotic prescribing practices in over 600 nursing homes showed that providers prescribe nearly 50% of antibiotics for longer than needed. It also found that about 20% of providers are responsible for almost 80% of antibiotic use.2

Shortening antibiotic courses to 7 days for common infections showed that providers could reduce the number of days patients use antibiotics by at least 20%.  Nursing homes who partner with consulting physicians and pharmacists with infectious disease training can reduce antibiotic use by 30% and experience lower rates of C. difficile.3

Outpatient Antibiotic Stewardship

A study audited providers’ antibiotic prescribing practices for certain respiratory infections, like colds or bronchitis, where antibiotics were not necessary. The study sent monthly e-mails to providers comparing them to top-performing peers who were not prescribing antibiotics for these conditions. This audit-feedback intervention lowered inappropriate antibiotic use for these respiratory infections from 20% to 4%.4

A 2014 studyexternal icon used a written public commitment poster to improve antibiotic prescribing and reduce inappropriate prescriptions. In the group of healthcare providers that used the poster, there was a 20% reduction in inappropriate antibiotic prescribing for respiratory infections, compared to providers who did not have the commitment poster.5

Another study found providers who received communication training prescribed fewer antibiotics for common respiratory infections than providers who did not receive the training.6 Three years after the training, providers who received communication training were still prescribing fewer antibiotics than those who did not receive the training.7

Resources
  • CDC Commitment Posterpdf icon
    Downloadable letter for physician offices to communicate the importance of appropriate antibiotic use to patients

1 Standiford, H., et al. (2012). “Antimicrobial stewardship at a large tertiary care academic medical center: cost analysis before, during, and after a 7-year program.” Infection Control and Hospital Epidemiology 33(4): 338-345.

2 Centers for Disease Control and Prevention. Core Elements of Hospital Antibiotic Stewardship Programs.  Accessed 2017 April 27.   Available at https://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html

3 Jump RLP, Olds DM, Seifi N, et al. Effective antimicrobial stewardship in a long-term care facility through an infectious disease consultation service: keeping a LID on antibiotic use. Infect Control Hosp Epidemiol. 2012;33(12):1185-1192.

4 Meeker D, Linder JA, Fox CR, et al. Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: a randomized clinical trial. JAMA. 2016;315:562–70. CrossRefexternal icon PubMedexternal icon

5 Hallsworth, M., et al., Provision of Social Norm Feedback to High Prescribers of Antibiotics in General Practice: A Pragmatic National Randomised Controlled Trial. The Lancet.

6Cals, J.W.L., et al., Effect of Point-of-Care Testing for C-Reactive Protein and Training in Communication Skills on Antibiotic Use in Lower Respiratory Tract Infections: Cluster Randomized Trial. BMJ. British Medical Journal, 2009. 338: p. b1374.

7 Cals, J.W.L., et al., Enhanced Communication Skills and C-Reactive Protein Point-of-Care Testing for Respiratory Tract Infection: 3.5-year Follow-up of a Cluster Randomized Trial. Annals of Family Medicine, 2013. 11(2): p. 157–64.