Mediclinic Adheres to World-Class Antibiotic Prescription Practices
Posted on 17 November 2017
Andriette van Jaarsveld, Clinical Pharmacy Specialist for Mediclinic Southern Africa, explains the dangers associated with inappropriate antibiotic prescriptions – and what Mediclinic is doing to decrease the development of microbial resistance.
What are the dangers or risks associated with improper antibiotic use?
All antibiotic use increases the development of antibiotic resistance, but the inappropriate use increases the pressure on our available antibiotics unnecessarily. Other risks include the development of diarrhoea (which can be life-threatening), candida infections, allergic reactions, renal and liver impairment. There are also other interactions between antibiotics and chronic medication, which can result in cardiac side-effects such as QT-prolongation or an increase in the international normalised ratio (INR).
How critical is microbial resistance in the South African context?
The situation is critical in South Africa. According to the State of the Worlds Antibiotics Report from Center for Disease Dynamics, Economics & Policy (CDDEP) that was released in 2015, the total antimicrobial consumption increased by more than 80% between 2000 and 2010. Yet, in a recent study published in the International Journal of Infectious Diseases by Schellack et al, a mere possible decrease of 2% was shown. We also see a significant increase in the resistance of microorganisms, which means patients are being treated with more toxic and expensive second-line antibiotics. For some patients, we don’t have good treatment options left.
What are the standard guidelines for prescribing antibiotics?
There are numerous international and local guidelines available. These include the South African Antibiotic Stewardship Programme (SAASP) Guideline and the South African guideline for the management of community-acquired pneumonia in adults. Evidence-based international guidelines include the Sanford guide to Antimicrobial Therapy and the Johns Hopkins Antibiotic Guidelines. Although prescribing in the public sector is guided by the Standard Treatment guidelines (STGs), prescribing in the private sector is mainly unrestricted. Doctors select whichever antimicrobial they feel is clinically most appropriate.
And what is Medlclinic doing to address this issue?
The Centers for Disease Control and Prevention (CDC) in the US recommends that every prescription should include the diagnosis and/or indication of the prescription. In order to support optimal antibiotic prescribing, Mediclinic – in collaboration with SAASP and in consultation with many of our prescribers – has designed its own Antibiotic Prescription Chart for their hospitalised patients.
What is an example of inappropriate antibiotic prescription?
Antibiotics are sometimes prescribed for viral infections, such as flu, and at times the inappropriate antibiotic, dose or duration of treatment, is chosen. Often, the prescribed course is too long, which also drives antibiotic resistance.
Are doctors guilty of prescribing antibiotics incorrectly?
In some cases yes, although I believe this is unintentional. It can be due to old prescribing habits, the rapidly evolving research about new best practice and the desire to satisfy their patients’ expectations. That said, there are ample online courses and continued professional education opportunities for prescribers to improve and update their knowledge about the appropriate use of antibiotics. Doctors should also be vigilant about performing the appropriate hand hygiene to prevent the spread of microorganisms between patients.
What is Mediclinic doing to prevent the spread of drug-resistant bugs?
Hospitals, such as Mediclinic, implemented Antibiotic Stewardship Programmes to support the appropriate use of antibiotics. Mediclinic also has strict Infection Prevention and Control Policies in place that guide hand hygiene, isolation protocols, environmental cleaning amongst other actions.