Antimicrobial Stewardship: Optimization of Antibiotic Practices

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.

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.

• 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

• 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.

• 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.

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

• 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.

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

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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.

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.

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.

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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.

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.