Stanford Antimicrobial Safety and Sustainability Program
On average, approximately 60% of hospitalized patients receive an antibiotic and in an estimated one-half of cases antibiotic use is inappropriate. The latter is the result of administration of an antibiotic when none is indicated, the use of the wrong antibiotic, incorrect dosing, or an incorrect duration of administration. This can result in harm to the patient as a result of the receipt of inadequate treatment for his or her infection, direct toxic effects of the antibiotic, allergic reactions, and superinfection with resistant bacteria, as well as collateral damage such as the development of colitis due to the toxins of Clostridium difficile.
In addition, antibiotic use, both appropriate and inappropriate, has the potential for important societal harm as a result of the selective pressure it exerts upon the bacterial ecology with the resultant increased prevalence of antimicrobial resistance. In this regard, antibiotics are unlike any other class of medications because of the potential public health consequences of their selection of resistant bacteria, which may become dominant in the hospital and the community.
Our mission is the optimization of antimicrobial use in order to ensure patient safety and best possible clinical results. To these ends, we work to make certain that antimicrobials are administered only when indicated and that the choice, dose, route, and duration of their administration is optimized in order to enhance patient outcomes while minimizing related adverse effects as well as the selection of microbial resistance.
News and Announcements
Doctors Stan Deresinski and Marisa Holubar presented at the Medicine Grand Rounds on July 18. Check out their lecture, "Antimicrobial Stewardship: The Fierce Urgency of Now," on the Education page under Webinars/Lectures.
Vancomycin AUC go-live on June 19th!
In collaboration with our colleagues at WHO Europe, we developed a new, free online course demonstrating ASP principles for front-line providers. Check it out!
Increasing Evidence of the Nephrotoxicity of Piperacillin/Tazobactam and Vancomycin Combination Therapy—What Is the Clinician to Do?
Hot off the press! Comprehensive Guidance for Antibiotic Dosing in Obese Adults
Bacteremia Due to MRSA: New Therapeutic Approaches (free download unil 8 July 2016)
Think twice about that fluoroquinolone prescription
The FDA has issued a drug safety communication warning about potentially disabling side effects associated with the use of fluoroquinolone antibiotics that “generally outweigh the benefits for patients with sinusitis, bronchitis, and uncomplicated urinary tract infections who have other treatment options”. These side effects can involve the tendons, muscles, joints, nerves and central nervous system. Even prior to the FDA warning, fluoroquinolones were either not indicated or were not first-line recommendations in the infections above. While the FDA warning pertains mostly to outpatient infections, it will remind clinicians to reconsider use of fluoroquinolones in both outpatient and inpatient settings.
Polymyxin B is now preferred over Colistin for infections due to MDR bacilli at SHC. See our guidebook for the Tip Sheet
Vancomycin per Pharmacy is now live at SHC