Guillermo Sanchez, MSHS, MPH is a Public Health Scientist and a Certified Physician Assistant with the Get Smart: Know When Antibiotics Work program. He specializes in antibiotic resistance trends and prevalence, antibiotic prescribing behaviors among outpatient providers, and state partnership outreach for the campaign.
Rising Threat of Antibiotic ResistanceOver 80 years after the discovery of antibiotics, rising antibiotic resistance has heralded the emergence of “nightmare bacteria” across the world. The recent Centers for Disease Control and Prevention (CDC) report,
Antibiotic Resistance Threats in the United States, 2013, conservatively estimates over 2 million people in the U.S. are infected with antibiotic-resistant bacteria annually and at least 23,000 die as a result. Antibiotic-resistant infections are more costly to treat, require longer hospital stays, and contribute to excess morbidity and mortality. Although the development of antibiotic resistance among bacteria may be inevitable, the proliferation of resistance can be slowed if antibiotics are used appropriately by both patients and healthcare providers. Fortunately, there are a variety of resources and tools available for public health officials to share with providers and the public to help
promote the proper use of antibiotics.
It has been reported that up to half of outpatient antibiotic prescriptions in the U.S. are inappropriate.1 One way to increase appropriate prescribing by healthcare providers is to improve adherence to clinical practice guidelines. Clinical practice guidelines are important to public health, because they reduce the variability with which infections are treated, minimize the unnecessary exposure of bacteria to antibiotics, and are based on the best scientific evidence available. Although local antibiotic resistance rates may dictate variations in prescribing practices, having a clinical decision-making framework for prescribing establishes a uniform starting point for diagnosing infections and subsequent evidence-based treatment. Sharing current clinical prescribing guidelines with providers may be one way public health professionals can improve prescribing within individual states and communities.
Managing Patient Expectations
Patient expectations for antibiotics are perceived as a widespread barrier to improving antibiotic misuse, since unwarranted demand increases the likelihood of inappropriate prescribing. Providers and the public health community should:
- Remind patients to take an antibiotic only when prescribed and medically necessary, and also to complete the course of antibiotics exactly as prescribed.
- Discourage patients from stopping their antibiotics when they feel better or saving them for a future illness.
- Disseminate educational tools and communication tips for patients presenting with cough and cold symptoms. These tools help providers communicate with patients about their illness and how it should be treated, including recommendations for symptomatic relief if an antibiotic is not warranted.
Role of State and Local Health Departments
Because of the widespread use of antibiotics and geographic variability of antibiotic resistance, state and local health departments play an integral role in the management of this emerging public health threat.
State and local public health departments are in a prime position to foster relationships with key opinion leaders in the community and local professional societies in order to encourage providers to prescribe appropriately and to help the public understand why an antibiotic may not be needed for cough or cold symptoms.
The Get Smart: Know When Antibiotics Work program has free
educational materials for download and distribution that can be useful for providers or the general public. Examples of potential partnerships include:
- Helping school districts provide educational materials through the school nurse’s office or at a community health fair
- Collaborating with local medical societies or physician groups to bring attention to new clinical guidelines
- Distributing antibiograms from regional medical centers to outpatient offices
- Working with health plans to identify high prescribers to target for education
The Get Smart: Know When Antibiotics Work program is committed to:
- Promoting the use of antibiotic prescribing guidelines among providers
- Decreasing demand for antibiotics among healthy adults and parents of young children
- Encouraging adherence to prescribed antibiotics for all patients
Local and state health departments are essential in this ongoing effort to improve antibiotic use in the U.S. For more information on how to receive materials or to learn more about the Get Smart: Know When Antibiotics Work program, please visit
the Get Smart website or email
the Get Smart program.
1. Centers for Disease Control and Prevention (CDC). Antibiotic resistance threats in the United States, 2013. Atlanta (GA): CDC; 2013. Available from: http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf
Public Health Foundation (PHF) is proud to be a partner of CDC’s Get Smart: Know When Antibiotics Work program by promoting and offering Get Smart Materials through PHF’s Learning Resource Center.
Through its Antibiotic Stewardship Program, PHF is also working to improve appropriate antibiotic use by leading an effort to develop and pilot a driver diagram for public health and healthcare to work together to reduce antibiotic resistant infections.
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