Culture shift: VRH scaling back antibiotic prescription under stewardship program

The following article is taken from the Eagle Times

Bottles of Amoxicillin sit on a counter top at Valley Regional Hospital as Clinical Pharmacist Reid Sindelar talks with Shannan Metzger, manager of Quality and Infection Prevention. — CAMERON PAQUETTE

Bottles of Amoxicillin sit on a counter top at Valley Regional Hospital as Clinical Pharmacist Reid Sindelar talks with Shannan Metzger, manager of Quality and Infection Prevention. — CAMERON PAQUETTECLAREMONT —

Patients looking for an antibiotic for their cough or sore throat may have to try other remedies before doctors sign off on the prescription.

Valley Regional Hospital has become part of a push to limit the prescription of antibiotics to patients who truly need them, reducing the potential for diseases caused by antibiotics and making the drugs more effective at combating bacterial infection.

“There’s been a huge push globally,” said Shannan Metzger, RN, BSN, CIC, Manager of Quality and Infection Prevention for Valley Regional Hospital. “An illness is really just a plane ride away.”

Metzger, who joined VRH in December 2014, began looking into antibiotic stewardship in 2015 as a way to complete her Master’s at the University of Vermont. Metzger, Clinical Analyst Amy Zullo and Clinical Pharmacist Reid Sindelar have headed up the recent effort, including educational materials that are being handed to patients.

The materials, which were rolled out last week, include a letter signed by VRH President and CEO Peter Wright and Medical Staff President James Wilton explaining antibiotic stewardship to patients. Antibiotics like penicillin and azithromycin fight infections due to bacteria, but can also cause side effects like skin rashes, diarrhea, or yeast infections, according to the letter.

“If you don’t have a bacterial infection, giving you antibiotics can actually make you sick, and make the bug resistant,” Metzger said.

Clostridium difficile colitis is a bacterial infection in the colon that can be caused by antibiotic use. The infection causes diarrhea and mild cramping, with fever and nausea also accompanying severe cases, according to the Mayo Clinic.

“It’s very painful. It could very well be life threatening in somebody whose immune system is not up to par,” Sindelar said.

Human intestines contain a variety of different bacterial cells, many of which help protect the body from infection. Prescribing an antibiotic, particularly broad spectrum antibiotics that attack all types of bacteria, can lead to the destruction of some of the helpful bacteria, according to Metzger.

Although issues tied to antibiotics have been known for a long time, antibiotic stewardship became more prevalent in the past several years as more antibiotic-resistant bugs such as MRSA and CRE infections started developing, Sindelar said.

Sindelar is currently in the process of receiving an Antimicrobial Stewardship Certificate from the Society of Infectious Diseases Pharmacists. He said it is important to prescribe the correct antibiotic so that only the harmful bacteria in the body are being targeted, and uses culture samples taken from patients to “narrow down” the bacterial infection and prescribe the best antibiotic to combat that particular bug.

The creation of antibiotics has greatly reduced morbidity and saved lives, but 20 to 50 percent of all antibiotics prescribed in United States acute care hospitals are either unnecessary or inappropriate, according to the Centers for Disease Control and Prevention. In fact, the organization estimates that more than 2 million people are infected with antibiotic-resistant organisms, resulting in approximately 23,000 deaths annually.

By only prescribing antibiotics to patients with definite bacterial infections, hospital officials hope to limit both the occurrence of illnesses related to side effects, and the development of antibiotic-resistant organisms.

“This is educating our community, our patients, and our [health care] providers,” Metzger said. “If we’re asking for the community to change their mindset, we need to help them know why.”

The sheet given to patients at VRH includes tips on proper use and storage of antibiotics, as well as instructions on how to manage symptoms for those with viral infections. Other tips include not saving the drugs for future use, or not flushing them down the toilet. Metzger said this leads to antibiotics getting into the water supply.

In the past, a healthy person visiting the hospital to report a lingering cough may have been given a seven-day prescription for an antibiotic. After several days, the patient would feel better and would stop taking the medication. Now, that same patient may instead be advised to take robitussin or warm salt water gargles, giving the body time “to do what it’s designed to do, which is fighting viruses effectively,” Metzger said.

“It’s the mindset of a pill will fix everything,” Sindelar said.