Physicians Key in Preventing Antibiotic Resistance

The Centers for Disease Control and Prevention (CDC), the Institute of Medicine (IOM), and other international and national public health authorities have identified antibiotic resistance as a significant public health concern for the 21st century. Decreasing the inappropriate use of antimicrobials is seen as a primary solution to this challenge.

Adherence to current antibiotic prescribing guidelines is assessed in three separate measures in the Healthcare Effectiveness Data and Information Set (HEDIS) tool. Humana's overall 2007 HEDIS scores indicate the following:

• The compliance rate for appropriate antibiotic treatment for adults with acute bronchitis was in the 50th percentile
  
• The compliance rate for appropriate treatment for children with upper respiratory infection (URI) was below the 10th percentile
• Compliance rate for appropriate treatment for children with pharyngitis remained high (above the 90th percentile)

In the fall of 2007, Humana launched an educational campaign to inform members of the latest guidelines for antibiotic use, including the dangers of antibiotic resistance. Hopefully, this effort will help reduce the pressure members often place on physicians to prescribe antibiotics in inappropriate situations.

Throughout the 2007-2008 flu season, Humana's quality nurses are also providing physicians with guidelines from the CDC about proper antibiotic usage to share with their patients. As a reminder, following is a summary of the current CDC prescribing guidelines for upper respiratory infections, adult bronchitis and acute pharyngitis:

• Upper respiratory infections: Antibiotic treatment is not recommended for viral etiologies.
• Adult bronchitis: Antibiotic treatment is not recommended in routine cases.
• Acute pharyngitis: Antibiotic treatment should be limited
  to patients with the highest likelihood of Group A beta hemolytic streptococcus (GABHS), as indicated by the presence of two or more of the following: (1) history of fever, (2) tonisllar exudates, (3) no cough, and (4) tender anterior cervical lymphadenopathy (lymphadenitis) and individuals have confirmation of strep with a rapid antigen test.

The CDC offers a wealth of resources to help physicians educate their patients on the issues surrounding antibiotic resistance. Links to current treatment guidelines and patient education materials can be found at
http://www.annals.org/cgi/content/abstract/134/6/509.

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