Lori Kestenbaum, MD

is a fellow in Pediatric Infectious Diseases at The Children’s Hospital of Philadelphia. She graduated with a BS in Psychology from Duke University and received her MD from the Perelman School of Medicine at the University of Pennsylvania. She completed her residency in Pediatrics at The Children’s Hospital of Philadelphia in 2012.  She is currently a member of the American Academy of Pediatrics, the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Follow her on Twitter @lorikestenbaum.

Working toward reduced overuse of antibiotics in the outpatient setting

Recently, I attended the Fifth Annual International Pediatric Antimicrobial Stewardship Conference at Children’s Mercy Hospitals and Clinics in Kansas City, Mo. There were about 100 attendees, all passionate about decreasing inappropriate antibiotic use and decreasing antibiotic use overall. In the inpatient setting, stewardship programs are growing and have the ability to provide real-time feedback to clinicians while the patient is still present in the hospital and a change in antibiotic regimen can be made.

However, the outpatient setting is difficult to target. If a provider prescribes a broad-spectrum antibiotic when a narrow-spectrum agent is more appropriate, the patient is out the door before a change can be made. 

So, how will we reduce overuse of broad-spectrum antibiotics in the outpatient setting? One idea mentioned was that antibiotics should be tracked like narcotics — you would have a license to give them, and your license would be closely tracked to monitor your prescribing habits.

Of course, the recommendation was in jest … but it made me think: How did we get here? Why do we need to police each other so aggressively? Don’t we all want what is best for the patients? 

In truth, an outpatient provider does want what is best for the patients. But providers also want the family to leave the office quickly, and they want the family to come back and continue seeing them. Frequently, an antibiotic prescription is seen as an easy way to achieve these goals. Who wins in this situation? The patient was likely to get better anyway if the cause of illness was a virus, so this method just exposes the patient to the unnecessary risks of antibiotics and leads to resistance across the nation. 

We have multiple strategies for working toward decreasing overuse of antibiotics in the outpatient setting: increased education; more rapid diagnostics; and changing patient satisfaction scores to reflect appropriate care.

In the meantime, I would like you all to take a look at the CDC campaign known as Get Smart: Know When Antibiotics Work. This website has an abundance of material available for clinicians to read and distribute to patients, along with posters than can be used in the office waiting room. It’s a first step in preventing antibiotic misuse.

The 2015 International Pediatric Antimicrobial Stewardship Conference will be held June 4 and 5 at Children's Mercy Hospitals and Clinics in Kansas City, Mo.