Never pressure your doctor to prescribe an antibiotic. Other ways to protect yourself and your family from infections, including resistant infections :. Skip directly to site content Skip directly to search. Español Other Languages. Antimicrobial Resistance Questions and Answers.

Español Spanish Print. Minus Related Pages. On This Page. What are bacteria? What is an antibiotic? What is antimicrobial resistance?

How can taking antibiotics contribute to antimicrobial resistance? Why should I care about antimicrobial resistance? How can I improve antibiotic use?

How can I protect myself and my family from antimicrobial resistance? Antibiotic Resistance Occurs When… [GIF — 8 MB] Transcript [TXT — B].

How to Use Antibiotics Steps you can take to use antibiotics appropriately. If your doctor decides an antibiotic is the best treatment when you are sick: Take the medication exactly as your doctor tells you.

Do not share your medication with others. Do not save them for later. Talk to your pharmacist about safely discarding leftover medicines. Do not take antibiotics prescribed for someone else. This may delay the best treatment for you, make you even sicker, or cause side effects.

Talk with your doctor and pharmacist if you have any questions about your antibiotics prescribed to you. Other ways to protect yourself and your family from infections, including resistant infections : Doing your best to stay healthy and keep others healthy Cleaning hands Covering coughs Staying home when sick Getting recommended vaccines, such as the flu vaccine.

Last Reviewed: November 15, Source: Centers for Disease Control and Prevention , National Center for Emerging and Zoonotic Infectious Diseases NCEZID , Division of Healthcare Quality Promotion DHQP. Facebook Twitter LinkedIn Syndicate.

home Antibiotic Use. To receive email updates about this page, enter your email address: Email Address. What's this? Links with this icon indicate that you are leaving the CDC website. The Centers for Disease Control and Prevention CDC cannot attest to the accuracy of a non-federal website.

Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Information technology staff are critical to integrating stewardship protocols into existing workflow.

Some examples include:. Nurses: There is growing recognition of the importance of engaging nurses in hospital stewardship efforts Nurses can play an especially important role in:. The antibiotic stewardship program must have a designated leader or co-leaders who are accountable for program management and outcomes.

Effective leadership, management and communication skills are essential for the leaders of a hospital antibiotic stewardship program Programs with co-leaders should have a clear delineation of responsibilities and expectations.

This can be especially important for physician leaders who do not work full time at the hospital. Antibiotic prescribing is ultimately under the direction of the medical staff. If a non-physician is the leader of the program, it is important that the hospital designate a physician who can serve as a point of contact and support for the non-physician program leader.

Larger facilities have achieved success by hiring full-time staff to develop and manage stewardship programs while smaller facilities report other arrangements, including use of part-time or even off-site expertise, sometimes referred to as tele-stewardship 34 , Hospitalists have also proven to be effective physician leaders or supporters for efforts to improve antibiotic use, especially in smaller hospitals, given their increasing presence in inpatient care, the frequency with which they use antibiotics and their experience with leading hospital quality improvement projects 21 , See additional posters highlighting key stewardship interventions for hospital pharmacists.

Highly effective hospital antibiotic stewardship programs have strong engagement of pharmacists, either as a leader or co-leader of the program 36 , It is important to identify a pharmacist who is empowered to lead implementation efforts to improve antibiotic use.

Infectious diseases trained pharmacists are highly effective in improving antibiotic use and often help lead programs in larger hospitals and healthcare systems 38 , In hospitals without infectious disease trained pharmacists, general clinical pharmacists are often co-leaders or pharmacy leaders.

There are a variety of resources to support the antibiotic stewardship efforts of clinical pharmacists, ranging from posters highlighting key stewardship interventions for pharmacists 40 to formal training and certificate programs in stewardship for pharmacists. Antibiotic stewardship interventions improve patient outcomes 7 , 9.

An initial assessment of antibiotic prescribing can help identify potential targets for interventions. Stewardship programs should choose interventions that will best address gaps in antibiotic prescribing and consider prioritizing prospective audit and feedback, preauthorization and facility-specific treatment guidelines.

Published evidence demonstrates that prospective audit and feedback sometimes called post-prescription review and preauthorization are the two most effective antibiotic stewardship interventions in hospitals Prospective audit and feedback is an external review of antibiotic therapy by an expert in antibiotic use, accompanied by suggestions to optimize use, at some point after the agent has been prescribed Audit and feedback can be implemented in a variety of ways, depending on the level of expertise available.

Stewardship programs with limited infectious diseases expertise might choose to focus reviews on comparing prescribed treatment courses to recommendations in hospital specific treatment guidelines and focus on common conditions, such as community-acquired pneumonia, urinary tract infection, or skin and soft tissue infection.

Programs with more advanced infectious diseases expertise might elect to review more complex antibiotic treatment courses. Preauthorization requires prescribers to gain approval prior to the use of certain antibiotics.

This can help optimize initial empiric therapy because it allows for expert input on antibiotic selection and dosing, which can be lifesaving in serious infections, like sepsis. It can also prevent unnecessary initiation of antibiotics Decisions on which antibiotics to place under preauthorization should be made in consultation with providers to focus on opportunities to improve empiric use, rather than on drug costs This intervention requires the availability of expertise and staff who can complete authorizations in a timely manner Hospitals can tailor the agents, situations, and mechanisms e.

preauthorization through an electronic order entry system to implement preauthorization based on program goals, available expertise, and resources in a way that does not delay therapy for serious infections.

Stewardship programs should monitor potential unintended consequences of preauthorization, especially treatment delays. Two studies have compared these two interventions directly and found prospective audit and feedback to be more effective than preauthorization 42 , However, many experts suggest that these interventions should both be priorities for implementation since preauthorization can help optimize initiation of antibiotics and prospective audit and feedback can help optimize continued therapy.

Facility specific treatment guidelines are also considered a priority because they can greatly enhance the effectiveness of both prospective audit and feedback and preauthorization by establishing clear recommendations for optimal antibiotic use at the hospital.

These guidelines can optimize antibiotic selection and duration, particularly for common indications for antibiotic use like community-acquired pneumonia, urinary tract infection, intra-abdominal infection, skin and soft tissue infection and surgical prophylaxis.

Recommendations may be based on national guidelines but should reflect hospital treatment preferences based on local susceptibilities, formulary options, and patient mix. Ideally, the recommendations should also address diagnostic approaches, such as when to send diagnostic samples and what tests to perform, including indications for rapid diagnostics and non-microbiologic tests e.

imaging, procalcitonin. The development of treatment guidelines is a good way for the stewardship program to engage prescriber stakeholders to develop consensus on antibiotic use. Stewardship programs can prioritize the development of guidelines based on the infections most commonly encountered.

Adherence to hospital guidelines can be enhanced by embedding treatment recommendations in order sets and clinical pathways. More than half of all antibiotics given to treat active infections in hospitals are prescribed for three infections where there are important opportunities to improve use: lower respiratory tract infection e.

community acquired pneumonia , urinary tract infection and skin and soft tissue infection Optimizing the duration of therapy can be especially important because many studies show infections are often treated for longer than guidelines recommend and data demonstrate that each additional day of antibiotics increases the risk of patient harm 4 , Examples of interventions are below and summarized in Table 1.

Optimizing the duration of therapy at hospital discharge is especially important as most excess antibiotic use in the treatment of community-acquired pneumonia occurs after discharge 48 , Urinary tract infection UTI : Many patients who are prescribed antibiotics for UTIs have asymptomatic bacteriuria that generally does not need to be treated.

Successful stewardship interventions focus on avoiding obtaining unnecessary urine cultures and avoiding treatment of patients who are asymptomatic, unless there are specific reasons to treat For patients who need treatment, interventions can focus on ensuring patients receive appropriate therapy based on local susceptibilities for the recommended duration Skin and soft tissue infection: Interventions have focused on ensuring patients with uncomplicated infections do not receive antibiotics with overly broad spectra e.

unnecessary coverage for methicillin-resistant Staphylococcus aureus MRSA and gram-negative pathogens and prescribing the correct route, dosage and duration of treatment 52 , Data also suggest that negative results of MRSA nasal colonization testing can help guide decisions to discontinue empiric therapy for MRSA pneumonia For patients with urinary catheters, avoid obtaining urine cultures based solely on cloudy appearance or foul smell in the absence of signs and symptoms of UTI.

Nonspecific signs and symptoms such as delirium, nausea and vomiting should be interpreted with caution as, by themselves, they have a low specificity for UTI.

Avoid antibiotic therapy for asymptomatic bacteriuria except in certain clinical situations where treatment is indicated, such as for pregnant women and those undergoing an invasive genitourinary procedure.

Use of therapy specific for MRSA may not be necessary in uncomplicated non-purulent cellulitis Sepsis: Early administration of effective antibiotics is lifesaving in sepsis. Antibiotic stewardship programs should work with sepsis experts in the hospital, along with the pharmacy and microbiology lab, to optimize the treatment of sepsis.

Important issues to address are:. Staphylococcus aureus infection: In many cases, therapy for MRSA can be stopped if the patient does not have an MRSA infection or changed to a beta-lactam if the cause is MRSA.

Studies have also shown that treatment protocols and, where available, infectious diseases consultation, can improve outcomes in patients with S. aureus bloodstream infections 59 , difficile infection : Treatment guidelines recommend providers stop unnecessary antibiotics in all patients diagnosed with C.

difficile infection. Reviewing antibiotics in patients with new diagnoses of C. difficile infection can identify opportunities to stop unnecessary antibiotics, which improves the clinical response of these infections to treatment and reduces the risk of recurrence Stewardship programs can also make sure that patients are receiving guideline recommended therapy for their C.

difficile infection Culture proven invasive infection: Invasive infections e. blood stream infections present opportunities for interventions to improve antibiotic use because they are easily identified from microbiology results and sub-optimal therapy often leads to worse outcomes.

Prospective audit and feedback of new culture or rapid diagnostic results may be particularly beneficial to reduce the time needed to discontinue, narrow, or broaden antibiotic therapy as appropriate. Review of planned outpatient parenteral antibiotic therapy OPAT : In some cases, OPAT can be optimized or even avoided altogether following a review by the antibiotic stewardship program However, providers often do not revisit the selection of the antibiotic after more data including culture results become available.

An antibiotic timeout is a provider-led reassessment of the continuing need and choice of antibiotics when the clinical picture is clearer and more diagnostic information, especially results of cultures and rapid diagnostics, is available.

Antibiotic timeouts are different from prospective audit and feedback because the providers, not the stewardship team, are doing the reviews. A trial demonstrated that antibiotic timeouts at hours of therapy improved the appropriateness of antibiotic selection, but did not reduce overall antibiotic use Antibiotic timeouts are a useful supplemental intervention but should not be considered a substitute for prospective audit and feedback by the stewardship program.

The optimal timing of antibiotic timeouts has not been established. Experts suggest that daily reviews of antibiotic selection, until a definitive diagnosis and treatment duration are established, can optimize treatment. Provider-led reviews of antibiotics can focus on four key questions 67 :.

There are several effective approaches to properly assess penicillin allergies, including history and physical examination, challenge doses, and skin testing 69 , Nurses may be able to play an important role in improving penicillin allergy assessments The microbiology lab in consultation with the stewardship program often implement the following interventions:.

Measurement is critical to identify opportunities for improvement and to assess the impact of interventions. Measurement of antibiotic stewardship interventions may involve evaluation of both processes and outcomes.

For example, a program will need to evaluate if policies and guidelines are being followed as expected processes and if interventions have improved patient outcomes and antibiotic use outcomes.

It is important for hospitals to monitor and benchmark antibiotic use by electronically reporting to the National Healthcare Safety Network NHSN Antimicrobial Use AU Option.

There are a variety of health information technology companies that can facilitate the reporting of antibiotic use data to the AU Option Stewardship programs can work with their information technology staff to explore options for reporting data to the AU Option.

The NHSN AU Option provides rates of antibiotic use expressed as days of therapy DOTs per days present for nearly all antibiotics for individual inpatient care locations, select outpatient care locations e.

emergency department and observation units , and for the entire hospital. Days of therapy are the sum of days for which any amount of a specific antibiotic agent is administered to a patient. Benchmarking has proven to be a powerful tool in hospital quality improvement and was a top priority for stewardship experts who advised CDC on the development of the NHSN AU Option.

The SAAR compares observed antibiotic use to predicted use, where use is predicted based on risk adjust models of data submitted to the NHSN AU Option SAARs were developed for a variety of groups of antibiotics for both adult, pediatric and neonatal care locations in response to suggestions from stewardship experts on the types of data that would be most actionable Stewardship programs are using the NHSN AU Option to both inform and assess interventions Hospitals that are not yet reporting to the NHSN AU Option can often get antibiotic use data from their pharmacy record systems, usually either as days of therapy or as defined daily doses DDDs.

The DDD estimates antibiotic use in hospitals by aggregating the total number of grams of each antibiotic purchased, ordered, dispensed, or administered during a period of interest divided by the World Health Organization-assigned DDD United States guidelines recommend the use of days of therapy rather than DDDs as the preferred numerator metric for hospital antibiotic use difficile infections are an important target for stewardship programs, given the evidence that improved antibiotic use can prevent these infections 85 , Most acute care hospitals are already monitoring and reporting information on C.

difficile infection prevention is multifaceted and creates an opportunity for stewardship programs to collaborate with other groups, such as the laboratory and infection prevention.

Antibiotic Resistance. Improving antibiotic use is important to reduce antibiotic resistance and presents another option for measurement.

The development and spread of antibiotic resistance is multi-factorial and studies assessing the impact of improved antibiotic use on resistance rates have shown mixed results 7 , 87 , The impact of stewardship interventions on resistance is best assessed when measurement is focused on pathogens that are recovered from patients after admission when they are under the influence of hospital stewardship interventions Monitoring resistance at the patient level i.

what percent of patients develop resistant super-infections has also been shown to be useful. Hospitals can also track antibiotic resistance though the NHSN Antimicrobial Resistance AR Option Financial Impact.

Stewardship programs can achieve significant cost savings, particularly drug cost savings. If hospitals monitor antibiotic costs, they should assess the pace at which antibiotic costs were rising before the start of the stewardship program After an initial period of marked savings, costs often stabilize.

However, it is important to continue support for stewardship programs since costs can increase if programs are terminated Process measures can focus on the specific interventions being implemented at the hospital.

Priority process measures include:. Antibiotic stewardship programs should provide regular updates to prescribers, pharmacists, nurses, and leadership on process and outcome measures that address both national and local issues, including antibiotic resistance.

Summary information on antibiotic use and resistance along with antibiotic stewardship program work should be shared regularly with hospital leadership and the hospital board.

Findings from medication use evaluations along with summaries of key issues that arise during prospective audit and feedback reviews and preauthorization requests can be especially useful to share with prescribers. Sharing facility-specific information on antibiotic use is a tool to motivate improved prescribing, particularly if wide variations in the patterns of use exist among similar patient care locations Provider specific reports with peer comparisons have been effective in improving antibiotic use in outpatient settings 95 , but there is limited experience with these reports for hospital-based providers.

CDC has a variety of educational resources, including a Training on Antibiotic Stewardship that includes a module focused on improving antibiotic use in hospitals Education is a key component of comprehensive efforts to improve hospital antibiotic use; however, education alone is not an effective stewardship intervention There are many options for providing education on antibiotic use such as didactic presentations, which can be done in formal and informal settings, messaging through posters, flyers and newsletters, or electronic communication to staff groups.

Education is most effective when paired with interventions and measurement of outcomes. Case-based education can be especially powerful, so prospective audit with feedback and preauthorization are both good methods to provide education on antibiotic use.

This can be especially effective when the feedback is provided in person, for example through handshake stewardship. Some hospitals review de-identified cases with providers to help identify changes in antibiotic therapy that could have been made. Education is most effective when tailored to the action s most relevant to the provider group, such as education on community acquired pneumonia guidelines for hospitalists or education on culture techniques for nurses.

patient education efforts. They should be engaged in developing educational materials and educating patients about appropriate antibiotic use.

Patient education is also an important focus for antibiotic stewardship programs. It is important for patients to know what antibiotics they are receiving and for what reason s. They should also be educated about adverse effects and signs and symptoms that they should share with providers.

Patients should be alerted to side effects that may occur after they have been discharged and even after they have stopped taking antibiotics. Engaging patients in the development and review of educational materials can make these items more effective.

Nurses are an especially important partner for patient education efforts. The Core Elements of Hospital Antibiotic Stewardship Programs is one of a suite of documents intended to help improve the use of antibiotics across the spectrum of health care.

Building upon the hospital Core Elements framework, CDC also developed guides for other healthcare settings:. CDC has also published an implementation guide for the Core Elements in small and critical access hospitals, Implementation of Antibiotic Stewardship Core Elements in Small and Critical Access Hospitals CDC will continue to use a variety of data sources, including the NHSN annual survey of hospital stewardship practices and AU Option, to find ways to optimize hospital antibiotic stewardship programs and practices.

CDC will also continue to collaborate with an array of partners who share a common goal of improving antibiotic use. With stewardship programs now in place in most US hospitals, the focus is on optimizing these programs.

CDC recognizes that research is essential to discover both more effective ways to implement proven stewardship practices as well as new approaches. CDC will continue to support research efforts aimed at finding innovative solutions to stewardship challenges. Skip directly to site content Skip directly to search.

Español Other Languages. Core Elements of Hospital Antibiotic Stewardship Programs. Minus Related Pages. Hospital antibiotic stewardship programs are essential to optimize patient care and help combat antimicrobial resistance. The Core Elements of Hospital Antibiotic Stewardship Programs, [PDF — 40 pages] outline structural and procedural components that are associated with successful antibiotic stewardship programs.

The antibiotic stewardship program assessment tool Print Only [PDF — 8 pages] is a companion to Core Elements of Hospital Antibiotic Stewardship Programs. This tool provides examples of ways to implement the Core Elements. Priorities for Hospital Core Element Implementation Highly effective implementation approaches that are supported by evidence and stewardship experts.

Implementation Resources for Hospitals Resources developed by CDC and partners to support the implementation of Core Elements of Hospital Antibiotic Stewardship Programs. Small and Critical Access Hospitals Guidance on practical strategies to implement antibiotic stewardship programs in small and critical access hospitals.

Introduction Antibiotics have transformed the practice of medicine, making once lethal infections readily treatable and making other medical advances, like cancer chemotherapy and organ transplants, possible.

Hospital antibiotic stewardship programs can increase infection cure rates while reducing : For More Information In Antibiotic Resistance Threats in the United States, , CDC estimates that more than 2. On This Page. Introduction Core Elements Implementation Summary of Updates Hospital Leadership Commitment Accountability Pharmacy Expertise Action Tracking Reporting Education CDC Efforts to Support Antibiotic Stewardship References.

Open All Close All. Core Elements Implementation Antibiotic Stewardship and Sepsis There have been some misperceptions that antibiotic stewardship may hinder efforts to improve the management of sepsis in hospitals. Summary of Updates Summary of Updates to the Core Elements of Hospital Antibiotic Stewardship Programs Optimizing the use of antibiotics is critical to effectively treat infections, protect patients from harms caused by unnecessary antibiotic use, and combat antibiotic resistance.

Major updates to the hospital Core Elements include: Hospital Leadership Commitment: Dedicate necessary human, financial and information technology resources. Priority examples of hospital leadership commitment emphasize the necessity of antibiotic stewardship programs leadership having dedicated time and resources to operate the program effectively, along with ensuring that program leadership has regularly scheduled opportunities to report stewardship activities, resources and outcomes to senior executives and hospital board.

Priority interventions include prospective audit and feedback, preauthorization, and facility-specific treatment recommendations.

Facility-specific treatment guidelines can be important in enhancing the effectiveness of prospective audit and feedback and preauthorization.

The update emphasizes the importance of actions focused on the most common indications for hospital antibiotic use: lower respiratory tract infection e. The antibiotic timeout has been reframed as a useful supplemental intervention, but it should not be a substitute for prospective audit and feedback.

A new category of nursing-based actions was added to reflect the important role that nurses can play in hospital antibiotic stewardship efforts. It is important for hospitals to electronically submit antibiotic use data to the National Healthcare Safety Network NHSN Antimicrobial Use AU Option for monitoring and benchmarking inpatient antibiotic use.

Priority process measures emphasize assessing the impact of the key interventions, including prospective audit and feedback, preauthorization, and facility-specific treatment recommendations. The update points out the effectiveness of provider level data reporting, while acknowledging that this has not been well studied for hospital antibiotic use.

The update highlights that case-based education through prospective audit and feedback and preauthorization are effective methods to provide education on antibiotic use. This can be especially powerful when the case-based education is provided in person e.

The update also suggests engaging nurses in patient education efforts. Hospital Leadership Commitment Support from the senior leadership of the hospital, especially the chief medical officer, chief nursing officer, and director of pharmacy, is critical to the success of antibiotic stewardship programs.

Priority examples of leadership commitment include: Giving stewardship program leader s time to manage the program and conduct daily stewardship interventions. Providing resources, including staffing, to operate the program effectively. Reporting stewardship activities and outcomes including key success stories to senior leadership and the hospital board on a regular basis e.

including stewardship measures in hospital quality dashboard reports. Other examples of leadership commitment include: Integrating antibiotic stewardship activities into other quality improvement and patient safety efforts, such as sepsis management and diagnostic stewardship.

Having clear expectations for the leaders of the program on responsibilities and outcomes. Making formal statements of support for efforts to improve and monitor antibiotic use.

Outlining stewardship-related duties in job descriptions and annual performance reviews for program leads and key support staff. Supporting training and education for program leaders e. attendance of stewardship training courses and meetings and hospital staff.

Supporting enrollment in and reporting to the National Healthcare Safety Network NHSN Antimicrobial Use and Resistance AUR Module 20 , including information technology support. Supporting participation in local, state, and national antibiotic stewardship quality improvement collaboratives.

Ensuring that staff from key support departments outlined below have sufficient time to contribute to stewardship activities. Key Support Hospital leadership can help ensure that other groups and departments in the hospital are aware of stewardship efforts and collaborate with the stewardship program.

Stewardship programs are greatly enhanced by strong support from the following groups: Clinicians : It is vital that all clinicians are fully engaged in and supportive of efforts to improve antibiotic use.

Help optimize empiric antibiotic prescribing by creating and interpreting a facility cumulative antibiotic resistance report or antibiogram. Laboratory and stewardship personnel can work collaboratively to present data from lab reports in a way that supports optimal antibiotic use and is consistent with hospital guidelines.

Guide discussions on the potential implementation of rapid diagnostic tests and new antibacterial susceptibility test interpretive criteria e. Microbiology labs and stewardship programs can work together to optimize the use of such tests and the communication of results.

Collaborate with stewardship program personnel to develop guidance for clinicians when changes in laboratory testing practices might impact clinical decision making Hospitals where microbiology services are contracted to an external organization should ensure that information is available to inform stewardship efforts.

Some examples include: Embedding relevant information and protocols at the point of care e. Implementing clinical decision support for antibiotic use and creating prompts for action to review antibiotics in key situations.

Facilitating and maintaining NHSN AUR reporting. Nurses can play an especially important role in: Optimizing testing, or diagnostic stewardship. For example, nurses can inform decisions about whether or not a patient has symptoms that might justify a urine culture.

Assuring that cultures are performed correctly before starting antibiotics. Prompting discussions of antibiotic treatment, indication, and duration. Improving the evaluation of penicillin allergies. Accountability The antibiotic stewardship program must have a designated leader or co-leaders who are accountable for program management and outcomes.

Pharmacy Expertise Antibiotic Stewards. Action Antibiotic stewardship interventions improve patient outcomes 7 , 9. Priority Interventions to Improve Antibiotic Use Stewardship programs should choose interventions that will best address gaps in antibiotic prescribing and consider prioritizing prospective audit and feedback, preauthorization and facility-specific treatment guidelines.

Common Infection-based Interventions More than half of all antibiotics given to treat active infections in hospitals are prescribed for three infections where there are important opportunities to improve use: lower respiratory tract infection e.

Table 1. Key Opportunities to Improve Antibiotic Use Key Opportunities to Improve Antibiotic Use Condition Diagnostic Considerations Empiric Therapy Definitive Therapy Tailor to culture results and define duration, including discharge prescription.

Community-acquired pneumonia 54 Review cases after initiation of therapy to confirm pneumonia diagnosis versus non-infectious etiology.

Guidelines suggest that in adults, most cases of uncomplicated pneumonia can be treated for 5 days when a patient has a timely clinical response 55 , Urinary tract infection UTI Implement criteria for ordering urine cultures to ensure that positive cultures are more likely to represent infection than bladder colonization Examples include: Order a urine culture only if the patient has signs and symptoms consistent with UTI such as urgency, frequency, dysuria, suprapubic pain, flank pain, pelvic discomfort or acute hematuria.

Establish criteria to distinguish between asymptomatic and symptomatic bacteriuria. Use the shortest duration of antibiotic therapy that is clinically appropriate. Skin and soft tissue infection Develop diagnostic criteria to distinguish purulent and non-purulent infections and severity of illness i.

Guidelines suggest that most cases of uncomplicated bacterial cellulitis can be treated for 5 days if the patient has a timely clinical response Show More. Other Infection-based Interventions Sepsis: Early administration of effective antibiotics is lifesaving in sepsis.

Important issues to address are: Developing antibiotic recommendations for sepsis that are based on local microbiology data. Ensuring protocols are in place to administer antibiotics quickly in cases of suspected sepsis.

Ensuring there are mechanisms in place to review antibiotics started for suspected sepsis so that therapy can be tailored or stopped if deemed unnecessary. Provider-led reviews of antibiotics can focus on four key questions 67 : Does this patient have an infection that will respond to antibiotics?

Have proper cultures and diagnostic tests been performed? How long should the patient receive the antibiotic s , considering both the hospital stay and any post-discharge therapy? Automatic changes from intravenous to oral antibiotic therapy: This change can improve patient safety by reducing the need for intravenous access in appropriate situations and for antibiotics with good absorption.

Dose adjustments: when needed, such as in cases of organ dysfunction, especially renal, or based on therapeutic drug monitoring. Dose optimization: for example, extended-infusion administration of beta-lactams, particularly for patients who are critically-ill and patients infected with drug-resistant pathogens.

Duplicative therapy alerts : Alerts in situations where therapy might be unnecessarily duplicative including simultaneous use of multiple agents with overlapping spectra e.

anaerobic activity and resistant Gram-positive activity 73 , Time-sensitive automatic stop orders: for specified antibiotic prescriptions, especially antibiotics administered for surgical prophylaxis. Detection and prevention of antibiotic-related drug-drug interactions: for example, interactions between some orally administered fluoroquinolones and certain vitamins.

Microbiology-based Interventions The microbiology lab in consultation with the stewardship program often implement the following interventions: Selective reporting of antimicrobial susceptibility testing results: tailoring hospital susceptibility reports to show antibiotics that are consistent with hospital treatment guidelines or recommended by the stewardship program 75 Comments in microbiology reports: for example, to help providers know which pathogens might represent colonization or contamination Nursing-based interventions Bedside nurses often initiate the following interventions: Optimizing microbiology cultures: Knowing proper techniques to reduce contamination and indications for when to obtain cultures, especially urine cultures Intravenous to oral transitions: Nurses are most aware of when patients are able to tolerate oral medications and can initiate discussions on switching to oral antibiotics.

Tracking Measurement is critical to identify opportunities for improvement and to assess the impact of interventions. Antibiotic Use Measures It is important for hospitals to monitor and benchmark antibiotic use by electronically reporting to the National Healthcare Safety Network NHSN Antimicrobial Use AU Option.

Outcome measures C. Process Measures for Quality Improvement Process measures can focus on the specific interventions being implemented at the hospital.

Priority process measures include: Tracking the types and acceptance of recommendations from prospective audit and feedback interventions, which can identify areas where more education or additional focused interventions might be useful.

Monitoring of preauthorization interventions by tracking agents that are being requested for certain conditions and ensuring that preauthorization is not creating delays in therapy.

Monitoring adherence to facility-specific treatment guidelines. If feasible, consider tracking adherence by each prescriber.

Additional process measures for quality improvement include: Monitoring the performance of antibiotic timeouts to assess how often they are preformed and if opportunities to improve use are being identified and acted on. Performing a medication use evaluation to assess courses of therapy for select antibiotics or infections to identify opportunities to improve use.

Standardized tools or antibiotic audit forms can assist in these reviews 92 Monitoring how often patients are converted from intravenous to oral therapy to identify missed opportunities to convert.

Assessing how often patients are prescribed unnecessary duplicate therapy, for example if a patient is prescribed two antibiotics to treat anaerobes.

Assessing how often patients are discharged on the correct antibiotics for the recommended duration. Reporting Antibiotic stewardship programs should provide regular updates to prescribers, pharmacists, nurses, and leadership on process and outcome measures that address both national and local issues, including antibiotic resistance.

Education CDC has a variety of educational resources, including a Training on Antibiotic Stewardship that includes a module focused on improving antibiotic use in hospitals CDC Efforts to Support Antibiotic Stewardship The Core Elements of Hospital Antibiotic Stewardship Programs is one of a suite of documents intended to help improve the use of antibiotics across the spectrum of health care.

Building upon the hospital Core Elements framework, CDC also developed guides for other healthcare settings: The Core Elements of Antibiotic Stewardship for Nursing Homes Core Elements of Outpatient Antibiotic Stewardship Core Elements of Human Antibiotic Stewardship Programs in Resource Limited Settings CDC has also published an implementation guide for the Core Elements in small and critical access hospitals, Implementation of Antibiotic Stewardship Core Elements in Small and Critical Access Hospitals References Rhodes A, Evans LE, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al.

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: Intensive care medicine.

Dellit TH, Owens RC, McGowan JE, Jr. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship.

Clin Infect Dis. Fridkin SK, Baggs J. Vital Signs: Improving Antibiotic Use Among Hospitalized Patients. MMWR Morb Mortal Wkly Rep. Tamma PD, Avdic E, Li DX, Dzintars K, Cosgrove SE. Association of Adverse Events With Antibiotic Use in Hospitalized Patients.

JAMA Intern Med. Huttner A, Harbarth S, Carlet J, Cosgrove S, Goossens H, Holmes A, et al.

Minus Related Pages. On This Page. What are bacteria? What is an antibiotic? What is antimicrobial resistance? How can taking antibiotics contribute to antimicrobial resistance? Why should I care about antimicrobial resistance?

How can I improve antibiotic use? How can I protect myself and my family from antimicrobial resistance? Antibiotic Resistance Occurs When… [GIF — 8 MB] Transcript [TXT — B]. How to Use Antibiotics Steps you can take to use antibiotics appropriately.

If your doctor decides an antibiotic is the best treatment when you are sick: Take the medication exactly as your doctor tells you. Do not share your medication with others.

Do not save them for later. Talk to your pharmacist about safely discarding leftover medicines. Do not take antibiotics prescribed for someone else. This may delay the best treatment for you, make you even sicker, or cause side effects.

Talk with your doctor and pharmacist if you have any questions about your antibiotics prescribed to you. Other ways to protect yourself and your family from infections, including resistant infections : Doing your best to stay healthy and keep others healthy Cleaning hands Covering coughs Staying home when sick Getting recommended vaccines, such as the flu vaccine.

Last Reviewed: November 15, Source: Centers for Disease Control and Prevention , National Center for Emerging and Zoonotic Infectious Diseases NCEZID , Division of Healthcare Quality Promotion DHQP. Facebook Twitter LinkedIn Syndicate.

home Antibiotic Use. For example, intestinal bacteria help us to digest food. When you use antibacterial or antimicrobial cleaning products, good bacteria are also killed. This could be harmful if the ratio of good to bad bacteria is disturbed, and bad bacteria get the upper hand.

Healthy households do not need antibacterial cleaning products. Effective hand washing with soap, and household cleaning using warm water and a plain detergent, is the cheapest way to get rid of germs. Avoid antibacterial or antimicrobial products — they are more expensive, no more effective at cleaning and their widespread use may pose a wider health risk.

Researchers have suggested that the modern obsession with cleanliness may be partly responsible for the increase in allergic asthma and conditions such as hay fever External Link allergic rhinitis.

It has also been suggested that some exposure to certain microbes may actually help regulate the immune system. This is based on the observations that growing up in a large family, being in child care from a young age and living with household pets seem to reduce the chances of developing allergic disease.

More research into this area is needed, but current understanding seems to suggest that the immune systems of children may need some exposure to bacteria and other microbes in order to function at their best.

In other words, a little dirt never hurt anyone. We should target our hygiene practices to the areas of greatest risk, such as washing hands after going to the toilet and before handling food. Food poisoning is a major health risk. Around 11, Australians are affected by food poisoning every day.

This is caused by poor food storage, preparation and handling. To reduce this risk:. This page has been produced in consultation with and approved by:. Anthrax is a rare but potentially fatal bacterial disease that occasionally infects humans.

Careful prescribing of antibiotics will minimise the emergence of antimicrobial resistant strains of bacteria. Aspergillus is a fungus that commonly grows on rotting vegetation.

It can cause asthma symptoms. The simplest form of prevention for lyssavirus is to avoid close contact with bats. Melissa shares her story of how her baby caught chickenpox at 5 weeks old. Content on this website is provided for information purposes only.

Information about a therapy, service, product or treatment does not in any way endorse or support such therapy, service, product or treatment and is not intended to replace advice from your doctor or other registered health professional.

The information and materials contained on this website are not intended to constitute a comprehensive guide concerning all aspects of the therapy, product or treatment described on the website.

All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions and to ascertain whether the particular therapy, service, product or treatment described on the website is suitable in their circumstances.

Ferran, A. Comparison of the reduction in the antibacterial potency of a fluoroquinolone conferred by a single mutation in the quinolone resistance-determining region or by the inoculum size effect.

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How Antibiotic Resistance Happens [PDF — 1 page]. Steps you can take to use antibiotics appropriately. Antimicrobial resistance can affect any person, at any stage of life. People receiving health care or those with weakened immune systems are often at higher risk for getting an infection. Antimicrobial resistance jeopardizes advancements in modern health care that we have come to rely on, such as joint replacements, organ transplants, and cancer therapy.

Aside from healthcare , antimicrobial resistance also impacts veterinary and agriculture industries. No one can completely avoid getting an infection, but there are additional steps you can take to protect yourself and your family.

Taking antibiotics only when they are needed is an important way you can protect yourself and your family from antimicrobial resistance. Talk to your doctor about the best treatment if you are sick. Never pressure your doctor to prescribe an antibiotic.

Other ways to protect yourself and your family from infections, including resistant infections :. Skip directly to site content Skip directly to search.

Español Other Languages. Antimicrobial Resistance Questions and Answers. Español Spanish Print. Minus Related Pages. On This Page. What are bacteria? What is an antibiotic? What is antimicrobial resistance? How can taking antibiotics contribute to antimicrobial resistance?

Why should I care about antimicrobial resistance? How can I improve antibiotic use? How can I protect myself and my family from antimicrobial resistance?

Antibiotic Resistance Occurs When… [GIF — 8 MB] Transcript [TXT — B]. How to Use Antibiotics Steps you can take to use antibiotics appropriately.

If your doctor decides an antibiotic is the best treatment when you are sick: Take the medication exactly as your doctor tells you. Do not share your medication with others. Do not save them for later. Talk to your pharmacist about safely discarding leftover medicines.

Do not take antibiotics prescribed for someone else. This may delay the best treatment for you, make you even sicker, or cause side effects. Talk with your doctor and pharmacist if you have any questions about your antibiotics prescribed to you.

A study found that an herbal therapy was just as effective as a chemical antibiotic in treating a small intestine bacterial overgrowth disorder. Honey is one the oldest known antibiotics, tracing back to ancient times.

Egyptians frequently used honey as a natural antibiotic and skin protectant. Honey contains hydrogen peroxide , which may account for some of its antibacterial properties. It also has a high sugar content, which can help stop the growth of certain bacteria.

Additionally, honey has a low pH level. This works to pull moisture away from bacteria, causing the bacteria to get dehydrated and die off. To use honey as an antibiotic, apply it directly to the wound or infected area.

The honey can help kill off the bacteria and aid in the healing process. If possible, opt for raw Manuka honey.

This form of honey offers the most health benefits. You can purchase raw Manuka honey here. You can also ingest honey to aid in the treatment of internal infections.

Simply swallow a whole tablespoon or stir it into a warm cup of herbal tea for a soothing treat. Honey is generally safe to use on the skin or in the body, though you should never give honey to an infant under 1 years old. Instead, consult your healthcare provider for an appropriate alternative.

Garlic has long been thought to have antimicrobial properties. A study found that garlic concentrate is effective against bacteria. You can purchase garlic concentrate or extract at your local health food store.

You may also be able to make your own by soaking a few garlic cloves in olive oil. Garlic is generally safe to ingest, but large doses might cause internal bleeding.

Up to two cloves per day is considered an acceptable dosage. Large doses of garlic can amplify the effects of this medication. Find a variety of garlic supplements here. Researchers in a study concluded that an extract of myrrh could kill off several everyday pathogens. This includes:. Myrrh is generally well-tolerated, but ingesting it may cause diarrhea.

If consumed in large doses, myrrh may cause heart problems. Buy myrrh extract now. Many all-natural household cleaners use thyme essential oil. This oil has been shown to be especially helpful against antibiotic-resistant bacteria.

In a study , researchers tested the effectiveness of both lavender and thyme essential oil. Both oils were tested in a pool of over strains of bacteria.

The researchers found thyme essential oil to be more effective at killing bacteria than lavender essential oil. Thyme essential oil is for external use only. Before applying to the affected area, be sure to dilute the essential oil with equal parts carrier oil.

Common carrier oils include coconut and olive oils. Purchase thyme essential oil and a carrier oil now. Carvacrol is an ingredient found in oregano essential oil.

It has important therapeutic properties that further activate healing in the body when inhaled. Carvacrol in oregano oil has been found to help heal gastric ulcers and reduce inflammation.

To treat fungal infections on your skin , add one drop of oregano essential oil per teaspoon of a carrier oil such as olive or coconut oil. Apply the mixture to the affected area. You can also diffuse oregano oil in the air to help clear sinus infections. Buy oregano essential oil here.

Be sure to discuss your interest in natural antibiotics with your healthcare provider. They can help you explore your options and help you weigh the potential benefits and risks of each regimen. Taking antibiotics for the sake of taking antibiotics can lead your body to build up a resistance to the medication.

You can learn ways to help prevent antibiotic resistance here. If your healthcare provider does prescribe you antibiotics, be sure to finish the entire treatment regimen. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

Experts say some antibiotics can kill healthy gut bacteria. They recommend people eat yogurt and other fermented foods while taking the medications. Is it true you can use certain honey on wounds? How the pros use it safely. And what can make honey….

Manuka honey has unique healing properties that other forms of honey do not. Find out how you can use Manuka honey to heal acne, treat wounds, and…. Antibiotics are a common and important type of medicine that treats bacterial infections. We've rounded up a list of the most common antibiotics.

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Though conventional treatments for H. pylori bacteria are your best bet for a speedy recovery, natural remedies may enhance first-line care.