Shorter. Safer. Better. Pledge Campaign
Antimicrobials are drugs that kill or prevent the growth of bacteria, viruses, fungi, or parasites. Antimicrobials can be life-saving therapies for patients with serious infections. For patients who do not have infections, antimicrobials are not helpful and increase the likelihood of developing antimicrobial resistance and patient harm. Antimicrobial stewardship programs including the Carolina Antimicrobial Stewardship Program help ensure patients with infections get the right drug, at the right dose, for the right length of time, or duration.
Too often, patients with common infectious syndromes such as urinary tract infections, pneumonia, and skin and soft tissue infections receive longer-than-needed antimicrobial treatment when a shorter duration would be equally effective.
Antimicrobial resistance is a top global public health threat, including here in the US. When an antimicrobial is no longer effective because of resistance, healthcare teams have fewer options to treat patients. Today, some pathogens are impossible to treat with existing antimicrobials. Such infections are regularly seen at UNC Medical Center. Currently, there are not enough new antimicrobials in development to replace the ones that no longer work. In the future, many people could die of common infections, as they did before the antimicrobials were invented. Antimicrobial stewardship is one way healthcare providers can help slow resistance.
Experts at the UNC Medical Center Carolina Antimicrobial Stewardship Program developed Best Practices for Durations of Antimicrobial Therapy to aid patient care teams as they select the best care for their patients. Each of us can be an antimicrobial steward. One important way for nurses, pharmacists, and prescribers to practice stewardship is by knowing, using, and promoting shorter antimicrobial durations whenever possible. Antimicrobials are drugs that prevent the growth of or kill bacteria, viruses, fungi, or parasites. Antibiotics are one type of antimicrobial that only work against bacteria. Today we have a wide range of antibiotics effective against various types of bacteria, but we need to be careful to preserve the effectiveness of these therapies in light of growing bacterial resistance. Most bacterial resistance is due to selection of resistant bacteria within a population. Antimicrobials kill only the susceptible pathogens, leaving resistant organisms behind, which can then thrive and increase in number without the competition from susceptible strains. Different drugs may then be needed to kill the resistant organisms. Today, some pathogens are very hard or impossible to treat with existing antimicrobials. Such infections are present here in North Carolina and have been seen at UNC Medical Center. When an antimicrobial is no longer effective, healthcare teams have fewer tools available to treat infections. CASP team members and allies have signed on to the Shorter. Safer. Better. pledge to demonstrate their personal commitment to know, use, and share the shortest effective antimicrobial durations in their practice. Please consider joining us. “I pledge to preserve antibiotics and do what is best for my patients by incorporating the shortest appropriate duration of antimicrobials into my practice. I will further action this commitment by…”[read more & take the pledge. UNC login required.] Print and share the Shorter. Safer. Better. flyer. See a list of those who have taken the pledge. Situation: A 35-year-old patient with acute bronchitis presents to an outpatient clinic. Intervention: Because of acute bronchitis cases are viral, no antibiotics are prescribed. The provider recommends rest and fluid at home and symptomatic therapies, knowing the condition will resolve on its own in a few weeks. Message: Antibiotics do not help people who do not have bacterial infections and may cause harm and contribute to antimicrobial resistance. Providers can direct patients to therapies that provide symptomatic relief. Situation: A four-year-old female patient is admitted for pyelonephritis. Urine culture is obtained and appropriate empirical therapy is begun. Once susceptibilities of the uropathogen are known, therapy is targeted and converted to oral. Intervention: The American Academy of Pediatrics recommends that pyelonephritis should be treated for 7-10 days. Recent literature suggests that shorter courses of 6-9 days are as effective as longer courses of 10+ days. Caution is required when there are significant functional or anatomic abnormalities of the urinary tract. Message: Duration of therapy for pyelonephritis and other urinary tract infections differs based on infection type and the patient’s urologic status. Use of narrow spectrum agents for the shortest effective durations is Shorter. Safer. Better. in action. Situation: A 65-year-old patient presents to the Emergency Department with community-acquired pneumonia (CAP). Intervention: Providers initiate appropriate empirical antimicrobial therapy based on the patient’s specific risks and clinical status. When the patient is afebrile and has no more than one clinical sign of instability, antimicrobial therapy is transitioned to the oral route and a total course of five days (including days of IV and oral therapy) is planned. Therapy can be targeted if a specific pathogen is found. Message: CAP is a common infection, but specific pathogens are not frequently found. The best way to balance the chances of benefit and harm from antimicrobial therapy is to use the shortest effective duration. Antimicrobial stewards across the UNC Medical Center are taking the pledge and using or encouraging colleagues to use the shortest effective durations.Common Questions
Take the Shorter. Safer. Better. Pledge
Examples of Shorter. Safer. Better. In Action
Stewards in Action
