Pill Problem: UPMC leads antibiotic overuse research

You may want to rethink asking your healthcare provider for an antibiotic at the first sniffle.

Launched in June, UPMC, the University of Wisconsin and the Society for Post-Acute and Long-Term Care Medicine (AMDA) are collaborating to study the overuse of antibiotics in hospitals and doctor’s offices. With UPMC leading, the researchers will conduct a three-year trial studying overuse and overprescription of antibiotics.

 Researchers say studying antibiotic use is important because antibiotic overuse and bacterium resistance is a pressing problem both nationally and worldwide. The U.S. Department of Health and Human Services Agency for Healthcare Research and Quality (AHRQ) is funding the study for an estimated $1.5 million. The formal launch of the trial is expected to begin in September.

Within the study itself, researchers will decide the groups receiving the control and experimental conditions randomly, as the study is a cluster randomized trial.

David A. Nace, who is leading the study at UPMC, said pharmaceutical companies can’t keep pace with bacterium evolution.

“We are very quickly running out of antibiotics to do the job for us, and the problem is only going to grow worse,” Nace said.

The trial will involve 40 long-term care facilities across Pennsylvania, Texas, North Carolina, and Wisconsin. The researchers will use 20 facilities as a control and and subject the additional 20 facilities to an antibiotic prescription.

Nace’s co-investigator, Christopher Crnich, said antibiotic overuse is “one of the most pressing public health problems we face.”

“While most providers understand the societal consequences of antibiotic overuse, these societal concerns have little influence on decision-making at the individual patient level,” Crnich said.

Only one new antibiotic was made between 2010 and 2013, Nace said, with only a few more coming to the market since 2013. Many doctors, physician assistants and nurse practitioners prescribe antibiotics to their patients every time they suspect an infection, but most of the time an infection is not actually occurring, Nace added.

“Providers often think an antibiotic won’t hurt, but that is the wrong assumption,” Nace said.

 According to Crnich, the negative side effects of incorrect antibiotic use include an elevated risk of adverse drug reactions, developing Clostridium difficile diarrhea, life-threatening colitis and becoming colonized with resistant bacteria.

 “While development of new antibiotics is important, the problem of antibiotic resistance will only be solved through changes in how we use antibiotics,” Crnich said.

 In the first year of the trial, researchers will evaluate and update the current guidelines for antibiotic use. Researchers will then collect data on urinary tract infections, including treatment provided, rate of appropriate treatment, rate of inappropriate treatment and adverse outcomes.

In the second year of the trial, researchers will begin coaching long-term care facilities and nursing homes on antibiotic use based on their findings and publish their results in the third year.

Mary Mulligan, Senior Manager of Clinical Affairs at AMDA, said she expects the study to show that overuse of antibiotics harms patients, rather than heals them.

She, Nace and the other researchers will include new interventions and guidelines in a toolkit that they will distribute to nursing homes across the country at the conclusion of the study.

 “We know antibiotics can save lives and we know antibiotics can kill people and make health worse. We need to use antibiotics appropriately,” Nace said.

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