Most of us have taken an antibiotic at some point in our lives. The majority of antibiotics 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.
Dr. Brad Crane, a pharmacist who specializes in infectious diseases and is the director of antibiotic stewardship program at Blount Memorial Hospital, 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. When it comes to antibiotics, the collateral damage could mean side effects, including a severe side effect called Clostridiodes difficile, or ‘C.diff,’ which is a serious, sometimes life-threatening type of diarrhea. Another unintended consequence unique to antibiotics is antibiotic resistance, meaning the antibiotic won’t kill the bacteria anymore. Do I really want to expose my ‘big gun’ antibiotic and take the chance that it might not work as effectively in the future? For specific patients, when I get more information, I can start tailoring the antibiotic to where I can just kill the one bug with less collateral damage – just like a sniper,” he explained. “This is a prime example of antibiotic stewardship,” he added.
“Antibiotic stewardship is trying to ensure that patients are receiving the 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, which I sometimes call the ‘triple-D’ or the best ‘Drug, Dose and Duration.’ A lot of times, it comes down to the simple fact that maybe the patient doesn’t need an antibiotic at all, such as infections caused by viruses – antibiotics don’t work on viruses. The hospital pharmacists and I work together with physicians to get key information about what options would be best for their patients. Ultimately, it’s the physician’s decision which antibiotics to use, but we work with them to recommend options to make sure the patients are getting what is best for them,” he explained. “At Blount Memorial, physicians are very welcoming of our discussions and are overall excellent stewards of our antibiotics,” 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, even if they know the antibiotic is not expected to make you feel better. We’re trying to shift the culture to where physicians don’t feel pressured into it, while simultaneously giving power back to the patient. When antibiotics are necessary, antibiotic stewardship results in patients getting the best antibiotic with the lowest risk of side effects,” he explained.
“At Blount Memorial, antibiotic stewardship is a team effort,” Crane continued. “It’s not just me or other pharmacists,” he said. “We work closely with physicians, nurse practitioners, physician assistants, our microbiology department, nurses, case managers, discharge planners and our infection control/prevention staff. If you need to be on an antibiotic, we all want to put you on the best antibiotic possible. In addition to the lower risk for side effects, doing this often 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 advanced rapid diagnostic testing – that is not available everywhere in our area – we can identify the specific organism 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. “We are also applying these same antibiotic stewardship concepts to physician offices and clinics throughout our community,” he added.