clinician in hospital with IV in foreground
HealthMay 19, 2021

Beyond the dose: Experts share antimicrobial stewardship roadmap

Since the start of the pandemic, researchers have observed a marked increase in antibiotic use. A review of COVID-19 case data found that more than 70% of these patients received antimicrobial treatment despite less than 10% having bacterial or fungal coinfections – amplifying risks for antimicrobial resistance. Experts discuss how to change that.

Clinicians are faced with many complex factors to consider when treating patients. Frontline pharmacist Emily Heil, PharmD, BCIDP, BCPS, AQ ID, AAHIVP, coordinator of the Antimicrobial Stewardship Program at the University of Maryland Medical Center and associate professor at the University of Maryland, and Sarah Wieczorkiewicz, PharmD, BCIDP, BCPS, FIDSA, senior clinical content specialist and co-author of The Pharmacist's Guide to Antimicrobial Therapy and Stewardship, discussed how healthcare providers can make antimicrobial stewardship a central piece of their patient safety efforts in a recent virtual panel discussion.

In the webinar, Heil and Wieczorkiewicz are joined by Liz Tomsik, PharmD, Senior Director for Reference Content, and Bill Alvarez, PharmD, BCPS, Director of Content Harmonization at Wolters Kluwer, Health, to moderate the discussion. Through use cases, they show how clinicians can better consider various physical changes and external modalities while using a central reference with the best available evidence and guidance in order to improve antibiotics prescriptions and curb resistance.

Renewed attention on antimicrobial resistance

The CDC's antimicrobial resistance (AR) efforts were thrust into the spotlight in 2013 with the AR Threats Report, a study that stratified pathogens by level of risk and recommended steps to start tracking and improving appropriate antibiotic use across the country in an effort to lower resistance. In 2019, a follow-up study revealed that since implementing the 2013 recommendations, there were:

  • 18% fewer deaths from antibiotic resistance overall
  • 28% fewer deaths from AR in hospitals

While these numbers seem encouraging, the CDC still reports more than 2.8 million annual cases of antimicrobial resistant infections in the U.S., including notably rising rates of infections related to erythromycin resistant invasive group A Streptococcus, drug-resistant Neisseria gonorrhoeae, and ESBL-producing Enterobacteriaceae.

The best "D"-fense: Diagnosis, Dose, De-escalation, Duration

In the webinar, Wieczorkiewicz shares how the antimicrobial stewardship model of Diagnosis, Dose, De-escalation, Duration, guides how clinical drug guidance is formulated and vetted by Lexicomp® editors and experts. Heil shares what information and guidance she most needs at a patient bedside. She cited complex renal function and obesity/body weight and how those conditions can affect drug disposition and dosing. She values having fast access to central insights into dosing for those complex conditions.

Alvarez noted that working with pharmacists in practice like Heil was vital to developing a more effective drug information resource. "We particularly focus on gaining expert clinical insight from both pharmacists and physicians," he added. "And instead of just reporting the facts, we go beyond providing just the dose to really synthesizing the content with a goal of improving patient outcomes and providing you the information at your fingertips."

video screen - Experts discuss roadmap for antimicrobial stewardship

portrait of Emily Heil
Emily Heil, PharmD, BCIDP, BCPS, AQ ID, AAHIVP

Emily Heil, PharmD, BCIDP, BCPS, AQ ID, AAHIVP, is coordinator of the Antimicrobial Stewardship Program at the University of Maryland Medical Center and an associate professor at the University of Maryland.

portrait of Sarah Wieczorkiewicz
Sarah M. Wieczorkiewicz, PharmD, BCIDP, BCPS, FIDSA

Sarah M. Wieczorkiewicz, PharmD, BCIDP, BCPS, FIDSA, is Senior Clinical Content Specialist for Infectious Diseases at Wolters Kluwer, Health, and co-author of The Pharmacist's Guide to Antimicrobial Therapy and Stewardship.

portrait of Liz Tomsik
Elizabeth Tomsik, PharmD

Elizabeth Tomsik, PharmD, Senior Director for Reference Content for Clinical Effectiveness at Wolters Kluwer, Health.

portrait of Bill Alvarez
William Alvarez, PharmD, BCPS

William Alvarez, PharmD, BCPS, is the Director of Content Harmonization for Clinical Effectiveness at Wolters Kluwer, Health.

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