If you’ve ever been sick – and, really, who hasn’t – the odds are good that you’ve been on an antibiotic at some point. And while there are, of course, many different types of antibiotics, there’s a good chance that a lot of them fall into one of two categories: generalized or specific. Generalized antibiotics tend to target a broad range of infections and illnesses, while specific antibiotics take aim at them on individual levels. As you might expect, a generalized antibiotic could very well work on a specific infection, but specific antibiotics probably won’t work on other infections that they’re not specifically designed to seek out and destroy. But, even if it could work and make you feel better, a generalized antibiotic might not be the best way to approach things, particularly if there’s a specific one that could do the job in a more precise way.
Brad Crane with the Blount Memorial Hospital pharmacy relates all this to “bombs” and “snipers.” “When a patient first arrives at the hospital, if we don’t know what infection he or she may have, the main goal is to kill whatever the organism is, so we have to use a ‘big gun’ or a ‘bomb’ antibiotic,” Crane said. “The ‘bomb’ is going to work, but think about all the collateral damage that happens using a bomb. This could mean side effects or kidney damage, but also we have a resistance issue. Do I really want to expose my big gun antibiotic and risk the idea that it might not work as effectively in the future? When I get more information, however, I can start tailoring the antibiotic to where I can just kill the one bug and have a lot less collateral damage,” he explained. “This is a prime example of antibiotic stewardship,” he added.
“Antibiotic stewardship is trying to ensure that patients are receiving the optimal, or best, antibiotic possible,” Crane continued. “That comes down to antibiotic selection, the appropriate dose, the way it’s given to the patient, and the amount of time they receive it. A lot of times, it comes down to the simple fact that maybe the patient doesn’t need an antibiotic at all. Most of my interactions are with physicians. I work with them to get key information about what options would be best for their patients. Ultimately, it’s the physician’s decision whether to use antibiotics, but I work with them to recommend options to make sure the patients are getting what is best for them,” he added.
So, how does all this affect you as a patient? Crane says information is your friend. “If you’re coming to the hospital and are going to be prescribed an antibiotic, the first question you should ask is whether you actually need to be on an antibiotic at all,” he said. “Sometimes, patients demand to be on an antibiotic, and it’s hard for physicians to refuse them even if they know they should. We’re trying to shift the culture to where physicians feel don’t pressured into it, while simultaneously giving power back to the patient,” he explained.
Crane says, at Blount Memorial, antibiotic stewardship is a team effort. “It’s not just me or other pharmacists,” he said. “We work really close with physicians, our microbiology department and our infection control coordinator. If you need to be on an antibiotic, we want to put you on the best antibiotic possible. In addition to the lower risk for side effects, doing this saves the patient money and time. Those ‘bomb’ antibiotics often are more costly, but if I can narrow it down to one specific one, it’s often cheaper for the patient. Also, with our rapid diagnostic testing, we can determine what the organism is more quickly, which places the patient on the optimal antibiotic faster and, in turn, typically shortens his or her stay in the hospital,” he explained.