Antimicrobial Stewardship: Optimization of Antibiotic Practices

ONLINE CME COURSE

Internet Enduring Material Sponsored by the Stanford University School of Medicine. Presented by the Division of Infectious Diseases in the Department of Medicine at the Stanford University School of Medicine

Course Description

Antibiotics are among the most frequently prescribed classes of drugs and it is estimated that approximately 50% of antibiotic use, in both the outpatient and inpatient settings, is inappropriate. At the same time, in contrast to any other class of drugs, every antibiotic use has a potential public health consequence – inappropriate use may not harm only the individual patient, but contributes to societal harm by exerting an unnecessary selective pressure that may lead to antibiotic resistance among bacteria.

This course will offer a number of illustrative cases, recognizable to the practicing physician in his or her practice to engage the learners in the thought processes that lead to optimal decision making, improved outcomes of individual patients, and harm reduction vis-a-vis the bacterial ecology.

Intended Audience

This course will offer a practical approach to prescribing antibiotic therapy and development of antimicrobial stewardship to physicians and pharmacists across all specialties and settings.

Dates, Duration and Fee

  • Original Release Date: November 22, 2013
  • Latest Review Date: October 15, 2016
  • Expiration Date: June 30, 2017
  • Estimated Time to Complete: 6 hours
  • CME Credits Offered: 6.00
  • Registration Fee: FREE

To Obtain CME Credits

  • Review the information below and complete the entire activity.
  • Complete the CME Post-test, CME Evaluation Survey, and CME Activity Completion Statement at the end of the activity.
  • You must receive a score of 75% or higher on the post-test in order to receive a certificate. You will have three attempts to answer each multiple-choice question (or one attempt for questions with only two options) to pass the post-test.
  • Once you attest to completing the entire online activity and have scored 75% or higher on the post-test, your certificate will be generated automatically and will be available on your Dashboard page.
  • Physicians will be awarded AMA PRA Category 1 Credits™. All other participants will receive a Certificate of Participation.

Learning Objectives

  • Develop skills to apply IDSA guidelines in treating common infections such as acute rhino-sinusitis.
  • Apply evidence based antibiotic management to treat sepsis.
  • Implement principles of antimicrobial stewardship when providing care to special populations and in various settings.
  • Apply evidence based antibiotic management to surgical patients requiring antibiotic prophylaxis.
  • Apply evidence based antibiotic stewardship program in the outpatient setting.

TABLE OF CONTENTS

1. Introduction

Navigating the Course

About the Course

Course Director/Faculty

2. The Basic Clinical Science of Antimicrobial Use

Test Your Knowledge (CME Pre-test)

Introduction to Antimicrobial Stewardship (6:18)

The Story of Penicillin (8:11)

Principles of Antimicrobial Use (14:38)

Principles of Antibacterial Pharmacokinetics & Pharmacodynamics (18:19)

Sepsis Case Study: Application of Principles (13:46)

Introduction to Bacterial Resistance (9:33)

Antibiotic Resistance: Gram Positive Resistance Beyond PCN (10:35)

Antimicrobial Resistance: Mycobacterial, Viral and Fungal Resistant (7:37)

Acute Bacterial Skin and Skin Structure Infections (4:12)

Antibiotic Allergies (12:08)

Cystitis (14:16)

Upper Respiratory Tract Infections (8:24)

Community Acquired Pneumonia in the Outpatient Setting (14:16)

3. Practical Aspects of Antimicrobial Stewardship and Application to Special Circumstances and Populations

Antibiotic Stewardship Interventions (9:46)

Convincing the C-Suite (13:54)

Measurements and Metrics (14:53)

Incorporating Clinical Decision Support into Stewardship (26:18)

Diagnostics (6:15)

Infection Prevention and Antimicrobial Stewardship (23:18)

Surgical Site Prophylaxis (6:50)

Out-Patient Parenteral Therapy (18:16)

Antimicrobial Stewardship in Pediatrics (20:44)

Antimicrobial Stewardship and Transplant Infectious Diseases (13:57)

Antimicrobial Stewardship: Long-term Care (29:11)

Antimicrobial Use at the end of life (23:53)

Conclusion (3:34)

4. Course Wrap-up

Concluding Remarks

CME Credit Instructions

CME Post-test

CME Evaluation Survey

CME Activity Completion Statement

5. Resources and References

Resources

References/Bibliography

6. Help!

Getting Help

Join our Mailing List

Disclosures

  • The following Course Director has indicated that he has a relationship with industry to disclose relative to the content of this activity during the planning phase. This relationship no longer exists and as a Speaker and Author he has nothing to disclose:
  • Stan Deresinski, MD, FIDSA
    Clinical Professor, Medicine
    Infectious Disease
    Antimicrobial Stewardship Program Medical Director 
    Stanford University School of Medicine
    Course Director
    Pfizer: Advisory Board member

    The following speakers have indicated that they have a relationship with industry to disclose relative to the content of this activity:

    Thomas File, Jr, MD, MACP, FIDSA, FCCP
    Professor of Internal Medicine
    Head ID Section
    Northeastern Ohio Universities Colleges of Medicine and Pharmacy
    Rootstown, Ohio
    Chief, Infectious Disease Service
    Summa Health System Akron, Ohio
    Speaker
    Astellas Pharma, Cubist, Durata, GlaxoSmithKline, Merck: Advisory Board member
    Pfizer, Boehringer Ingelheim, Gilead, Tibotec: Research
    Bayer AG, Daiichi Sankyo, Forest: Consulting

    Jason Newland, MD, MEd
    Medical Director, Patient Safety and System Reliability; Associate Professor of Pediatrics,
    University of Missouri-Kansas City School of Medicine
    Children’s Mercy Hospital Kansas City
    Speaker
    Pfizer: Research

The following co-course director, planners, speakers, authors, and reviewers have indicated that they have no relationships with industry to disclose relative to the content of this activity.

Stan Deresinski, MD, FIDSA
Clinical Professor, Medicine
Infectious Disease
Antimicrobial Stewardship Program Medical Director
Stanford University School of Medicine
Speaker and Author
Content Reviewer for Renewal

Lucy Tompkins, MD, PhD, FIDSA
Hospital Epidemiologist
Infectious Disease
Stanford Hospital and Clinics
Co-Course Director, Content Reviewer, and Speaker

Elizabeth Robilotti, MD, MPH
Infectious Disease Fellow
Antimicrobial Stewardship Program
Stanford University School of Medicine
Principal Planner and Speaker

Emily Mui, PharmD, BCPS
Infectious Disease Pharmacist
Antimicrobial Stewardship Program
Stanford University School of Medicine
Planner and Speaker

Niaz Banaei, MD
Assistant Professor of Pathology and Medicine (Infectious Diseases)
Director, Clinical Microbiology Laboratory
Stanford University School of Medicine
Speaker

Anne Liu, MD
Clinical Assistant Professor, Pediatrics - Immunology and Allergy
Clinical Assistant Professor, Medicine - Infectious Diseases
Pediatric Allergy & Immunology Clinic
Stanford University School of Medicine
Speaker

Kavita Trivedi, MD
Public Health Medical Officer
Healthcare Associated Infections Program
Center for Health Care Quality
California Department of Public Health
Collaborator and Speaker

Sasha Madison, MPH 
Manager, Infection Prevention and Control Department 
Stanford Hospital and Clinics
Speaker 

R. Michael Buckley, MD
Executive Director
Pennsylvania Hospital
Professor of Clinical Medicine
Perelman School of Medicine
University of Pennsylvania
Speaker

Conan MacDougall, PharmD, MAS, BCPS
Associate Professor of Clinical Pharmacy
University of California San Francisco School of Pharmacy
Speaker

Kristi Kuper, PharmD, BCPS
GSPC Clinical Pharmacy Manager
VHA Performance Services
Speaker

Preeti N. Malani, MD, MSJ
Associate Professor of Internal Medicine
Divisions of Infectious Diseases and Geriatric and Palliative Medicine
University of Michigan Medical School
Veterans Affairs Ann Arbor Healthcare System
Speaker

Technical Design and Development

  • Mike McAuliffe
    Stanford EdTech 
  • Pauline Becker
    Stanford EdTech 
  • Relly Brandman
    Coursera

Hardware/Software Requirements

  • Computer with Internet connection
  • Current version of Chrome or Safari browser. You must have javascript enabled.

Accreditation and Designation of Credits

The Stanford University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

The Stanford University School of Medicine designates this enduring material for a maximum of 6.00 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support Acknowledgement

Stanford University School of Medicine has received and has used undesignated program funding from Pfizer, Inc. to facilitate the development of innovative CME activities designed to enhance physician competence and performance and to implement advanced technology. A portion of this funding supports this activity.

Cultural and Linguistic Competency

California Assembly Bill 1195 requires continuing medical education activities with patient care components to include curriculum in the subjects of cultural and linguistic competency. It is the intent of the bill, which went into effect July 1, 2006, to encourage physicians and surgeons, CME providers in the State of California and the Accreditation Council for Continuing Medical Education to meet the cultural and linguistic concerns of a diverse patient population through appropriate professional development. The planners and speakers of this CME activity have been encouraged to address cultural issues relevant to their topic area. The Stanford University School of Medicine Multicultural Health Portal also contains many useful cultural and linguistic competency tools including culture guides, language access information and pertinent state and federal laws.

CME Privacy Policy

CONTACT INFORMATION

If you are having technical problems (video freezes or is unplayable, can't print your certificate, etc.) you can submit a Help Request to the OpenEdX Team. If you have questions related to CME credit, requirements (Pre-test, Post-test, Evaluation, Attestation) or course content, you can contact the CME Online support team at cmeonline@stanford.edu.

Bibloigraphy

Levy-Hara G, Amábile-Cuevas CF, Gould I, et al; International Society of Chemotherapy Antimicrobial Stewardship Working Group. "Ten Commandments" for the appropriate use of antibiotics by the practicing physician in an outpatient setting. Front Microbiol. 2011;2:230. PMID: 22164154

Grover ML, Nordrum JT, Mookadam M, et al. Addressing antibiotic use for acute respiratory tract infections in an academic family medicine practice. Am J Med Qual. 2013;28(6):485-91. PMID: 23401621.

For a complete list, please view the References/Bibliography page of the Course.

Course Details

  • Original Release Date:  November 22, 2013
  • Latest Review Date:  October 15, 2016
  • Expiration Date: June 30, 2017
  • Estimated Time to Complete: 6 hours
  • CME Credits Offered: 6.00
  • Registration Fee: FREE

Contact Information

For further information regarding the content, CME credit, or if you experience any technical difficulties with this enduring material please send us an email. 

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