Antibiotic-resistant infections and appropriate antibiotic use.
The antibiotic revolution has transformed medicine. But even Alexander Fleming—who pioneered it with his discovery of penicillin—warned about the dangers of antibiotic resistance as early as 1945, in his Nobel Prize acceptance speech.3
Today, our use of antibiotics has resulted in resistance for nearly all antibiotics developed to treat serious infections since the 1940s. These antibiotic resistant microorganisms have been described by world leaders as "nightmare bacteria" that "pose a catastrophic threat" to people in every country in the world.1 In a global survey that gathered data from 114 member countries, the WHO observed very high resistance rates in both hospital-acquired and community-acquired infections in every region. Astoundingly, the data showed that resistance rates of E. coli, K. pneumoniae, and S. aureus to commonly used antibiotics frequently exceeded 50 percent.4
Antibiotic use and today’s reality.
As you know, it’s often necessary to treat patients with serious infections empirically while you’re waiting for the causative microbe to be identified. But it isn’t always feasible to wait for results to come in from the lab, especially if they turn out to be inconclusive or polymicrobial, as often happens.5,6
Rise up. Join the fight against antibiotic resistance.I WANT MORE INFORMATION
Admitting the problem: the hospital stay burden.
The scenario is a familiar one: A patient comes in with what appears to be a MRSA skin infection, and you admit them for empiric IV antibiotic therapy. How optimal is this? Are patients staying in the hospital longer than they need to? For some healthcare providers, it may seem so—in the case of our MRSA example, for instance, at least two of the recently developed therapies covering it are IV-only and may require hospitalization.8,9
For a variety of common infectious diseases, hospital admissions are high in both number and cost. Community-acquired pneumonia accounts for 600,000 to 1.1 million hospitalizations per year in the United States, with an annual cost of over $17 billion.10 A study looking at admissions for acute bacterial skin and skin structure infections (ABSSSIs) from 2005-2011, revealed an average stay of 5.2 days at a cost of approximately $10,000 per stay.11 Another study showed that ABSSSI admissions increased by 73 percent between 1997 and 2011.2
The risks of IV antibiotics and length of hospital stay.
Of course, this isn't just about the material costs of stay and treatment. It's also about the health of our patients. Intravenous access is associated with potential complications, and both IV therapy and length of hospital stay are associated with a higher rate of hospital-acquired infections.12,13,14,15
Moreover, up to 80 percent of patients prefer to be treated at home.16 So, what’s stopping us?ADMISSIONS ARE A CONCERN
According to one study, the most common reason for not making the IV-oral switch is the lack of effective, oral alternatives.15
A little switch, a big change: why bioequivalence matters.
The idea seems simple enough. Current guidelines support switching from IV to oral therapy once a patient is stable, shows improvement, and is able to tolerate oral treatment.16 But this doesn't always happen. As far back as 2003, a study of 89 patients with MRSA showed that almost 70 percent of patients met the criteria for IV-to-oral switch therapy. How many of them actually received oral treatment? Just 10 percent.17 It's been a while since then—yet very little has changed. Why?
More bioequivalent oral options may help fight resistance.
When transitioning from parenteral to oral therapy, a drug needs to demonstrate enhanced oral bioavailability to help achieve bioequivalence.13 Too often, this option isn’t available to healthcare providers. But when it is, more physicians might be ready to make the transition18 for stable patients able to tolerate oral treatment.16 In a 12-month intervention study designed to encourage switching patients from IV to oral therapy, researchers found that the patients who were successfully switched to oral antibiotics were more likely to have been started on an antibiotic with both IV and oral formulations.18
And that could lead to shorter hospital stay, lower healthcare costs, and reduced health risks for hospitalized patients.13ORAL OPTIONS ARE IMPORTANT
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