Situation

Antibiotics are very strong drugs, and they fight infections caused by bacteria. However, the inappropriate or over-utilization of a broad-spectrum antibiotic has a lot of side effects that includes a dangerous form of diarrhea. Other side effects of overusing a broad-spectrum antibiotic include vomiting, vaginal infections, serious allergic reactions like swelling of throat and face, breathing complications, rashes, and nausea. Even in more severe cases, antibiotics are known to cause permanent nerve damage and torn tendons3. Furthermore, overprescribing antibiotics is a problem that is contributing to the rise of antimicrobial resistance. Inappropriate uses of antibiotics include, but are not limited to, subtherapeutic doses, excessive treatment duration, antibiotics that are medically not indicated, and over usage of broad-spectrum antibiotics.  

Background

        The use of a broad spectrum of antibiotics is only needed when the patient is not getting better, when the tests show that the drug resistant bacteria is responsible for the infections, or if the diagnosis results were unclear or could not be done. Broad spectrum antibiotics are often costly as compared to the narrow-spectrum drugs. Sometimes a patient may be required to stay in the hospital for a longer period because it is administered intravenously2. Unfortunately, an inappropriate use or overutilization of a broad spectrum of antibiotics is more likely to lead to bacteria resistance leading to prolonged illnesses. The narrow spectrum of antibiotics is commonly used by doctors and this medication only kills one type of bacteria3. The reduction of the antibiotics is called de-escalation and it can be used to improve a patient’s treatment and prevent the overuse of antibiotics.

Assessment

        Inappropriate initiation of a broad-spectrum of antibiotics, especially when a patient does not present with risk factors for multidrug resistant organisms, is dangerous to a patient because it might lead to antibiotic resistance by the bacteria causing the illness. Furthermore, an inappropriate initiation of a broad spectrum of antibiotics to a patient not requiring them may result in more adverse side effects like nausea, vomiting, and breathing complications. The continuation of a broad-spectrum of antibiotics when the patient’s susceptibility suggests a more tailored and narrower therapy is not recommended because it can lead to prolonged illness and stay at the hospital due to bacteria resistance to the antibiotic. In conclusion, continuing with a broad-spectrum antibiotic while the patient’s condition suggests otherwise increases the risks of death and morbid complications.

Recommendation

        It is often a good recommendation to de-escalate antibiotic therapy when the patient demonstrates improved clinical outcomes. The goal of antibiotic treatment is often to provide treatment against the pathogens that are responsible for causing an illness. Numerous research has associated inappropriate, overutilization and inadequate administration of antibiotic treatment to patients with elongated stay at hospitals, increased morbidity, and mortality2. The treatment of serious bacterial infections often requires precise therapy that aims at killing the likely pathogens until a culture or susceptibility test results are acquired.

         It is often a good practice to adjust a patient’s prescription to antibiotics according to their clinical outcomes. For instance, when a patient continuously showcases no signs of improvement while using a narrow-spectrum medication, his/her medication can be increased to the broad-spectrum treatment. Alternatively, when a patient’s medication is a broad-spectrum treatment, and their clinical outcomes improves, the medication can be reduced to narrow spectrum to avoid cases of antibiotic resistance and increased length of stay at a hospital facility3. Tailored therapy is often recommended for patients needing antibiotic treatment in order to reduce drug resistance by the illness causing bacteria.

References

1. Cordoba, Gloria & Søerensen, Tina & Holm, Anne & Bjornvad, Charlotte & Bjerrum, Lars & Jessen, Lisbeth. (2015). Exploring the feasibility and synergistic value of the One Health approach in clinical research: Protocol for a prospective observational study of diagnostic pathways in human and canine patients with suspected urinary tract infection. Pilot and Feasibility Studies. 1.

2. Mohayya, S., Narayanan, N., Cimilluca, D., Vaidya, P., Malanowski, A., & Bhowmick, T. (2019, October). 1033. Effectiveness of a Physician-Driven Automated Antibiotic Time Out in the Setting of Gram-negative Bacteremia. In Open Forum Infectious Diseases (Vol. 6).

3. Pulia, M., Liang, S., & May, L. (2014). Antibiotic Stewardship 101: An Intro for Emergency Physicians. Common Sense: The Newsletter of the American Academy of Emergency Medicine, 21(1), 31-33.

Appendix

Figure 1.0. Definition of appropriate and inappropriate use of antibiotics.

You may want to include specific recommendations as to how you will ensure limiting use of broad spectrum antibiotics by listing out specific policies and procedures and how pharmacists will be involved in this.