Fighting Antimicrobial Resistance: The Right Drug, Right Dose, Right Time

You have heard about COVID-19 but there’s another slow-growing pandemic in our midst: antimicrobial resistance (AMR). The World Health Organization (WHO) named AMR one of the biggest threats to global health today, as it puts the achievements of modern medicine in jeopardy, reverting curable illnesses into deadly diseases.

Antimicrobial Resistance Explained

What happens when the drugs used to treat infections no longer work? It sounds like a synopsis of a bad horror movie, but that's the question surrounding antimicrobial resistance. The misuse or the overuse of antibiotics is the main cause of AMR. Bacteria develops the ability to resist medications that were created to kill them. This makes infections harder to treat and raises the risk of disease transmission, severe illness and can even lead to death.

According to the Centers for Disease Control and Prevention (CDC), more than 2.8 million antibiotic-resistant infections occur in the U.S. each year, and more than 35,000 people die as a result.

In the U.S., prevention and infection control efforts reduced deaths from antibiotic-resistant infections by 18 percent overall and by nearly 30 percent in hospitals. However, antibiotic resistance is still a problem for far too many people. More action is needed to fully protect people.

Best Practices of Antibiotic Use

In order to mitigate AMR, healthcare providers need to embrace responsible prescribing of antibiotics to their patients. That’s where the Antimicrobial Stewardship Program (ASP) comes in. This initiative ensures healthcare organizations are only prescribing antibiotics when they are necessary and appropriate.

This can be a challenge for some hospitals. The CDC reports that up to 50 percent of antibiotics are prescribed inappropriately within U.S. hospitals.

According to the CDC, focusing on the appropriate use of antibiotics:

• Reduces treatment failures.
• Protects patients from adverse side effects.
• Lowers antibiotic resistance.
• Brings down hospital costs and lengths of stay.

A New Approach

PINC AI™ has assisted a number of healthcare organizations in establishing effective antimicrobial stewardship programs that improve surveillance, reduce inappropriate use and prevent the spread of resistant infections.

Clinical surveillance tools with an antibiogram feature, such as those powered by TheraDoc®, show a hospital’s antibiotic resistance pattern and which infections are more likely to resist antibiotics and consequently be ineffective for treatment.

“Health systems with facilities spread throughout large urban and rural areas can have different resistance patterns,” said Craig Barrett, Pharm.D., BCPS, Senior Product Director of Clinical Surveillance at Premier. “While one drug may work well for patients in rural areas, it may not be appropriate for patients in urban facilities.”

Effective clinical surveillance solutions collect drug resistance data to guide decisions. This ensures clinicians in individual settings have access to the most appropriate antibiotic for their patients.

TheraDoc allows pharmacists to easily view lists of patients receiving antibiotic therapy for stewardship rounds and to monitor patients who may need to have their antibiotics adjusted. When it comes down to it, in order to control AMR, providers must prescribe the right drug at the right dose for the right length of time.

TheraDoc also provides alerts to deescalate antibiotic therapy, notify of bug-drug mismatches and offers an integrated precision vancomycin dosing tool from InsightRX.

Guidelines recommend vancomycin be monitored and dosed based on area under the curve (AUC) rather than trough levels. This recommendation is driven by increasing evidence suggesting that AUC-based dosing can reduce incidence of acute kidney injury events compared to trough-based dosing.

The integration of InsightRX with TheraDoc offers fast, accurate Bayesian model precision dosing to perform antimicrobial therapeutic drug monitoring (TDM) assessments. Optimal achievement of anti-infective therapeutic levels is a core component of antimicrobial stewardship and — along with proper prescribing patterns, susceptibility testing and appropriate de-escalation — can help to prevent antimicrobial treatment failure and resistance.

“Precision dosing is bringing us closer to more accurate, predictable and powerful healthcare that is tailored to each patient’s specific needs,” said Barrett. “It allows pharmacists to deliver safer drug administrations and more effective treatments for a variety of diseases that diminish our health.”

Measuring Improvement

It is important for health systems to monitor and benchmark antibiotic use. The CDC’s monitoring program, the Antibiotic Use Option of the National Healthcare Safety Network (NHSN), captures electronic data on antibiotic use in a hospital, enabling monitoring of use in each unit.

TheraDoc can help health systems facilitate automated antimicrobial resistance and antimicrobial utilization reporting to the NHSN. Submitting this data allows hospitals to track their own use and benchmark with other facilities both nationally and regionally to measure performance.

TheraDoc also provides medication utilization analysis (MUA) reports to look at days of therapy (DOT) of antibiotics to assess their usage of antibiotics. This is important because the shortest duration of therapy is most desirable.

“Many pharmacists are looking to reduce overall antimicrobial spend especially given the COVID-19 pandemic,” according to Craig Reeder, PharmD., Director Clinical Pharmacy Analytics at Premier.

Antimicrobial cost savings can be viewed as a positive, this isn’t always the case. For example, putting someone on a less expensive drug isn’t necessarily better unless the patient outcomes are better.

PINC AI Service Line Analytics (SLA) allows users to look at drug utilization and spend. Clinicians can monitor medications with high acquisition cost, measure case volume and benchmark utilization relative to peers. This enables health systems to make smarter, evidence-based interventions and reinforces appropriate use and treatment guidelines.

Medications can only work properly if they are used correctly. Deciding when to prescribe an antibiotic can be a complex process. However, when providers leverage industry-leading and data-driven PINC AI clinical decision tools, inappropriate prescribing can be reduced — which in turn can reduce the threat of resistance.

Learn more about Premier’s commitment to reducing antimicrobial resistance.

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