Healthcare delivery has changed a lot during my career. One challenge is that patients see themselves as consumers. This changes patient expectations when they seek medical care. Specific to antibiotic stewardship, patients sometimes demand antibiotic prescriptions even when antibiotics are not indicated. For example, many patients seen in urgent care clinics assume that respiratory infections will go away faster with antibiotics. If the physician or provider tells the patient that antibiotics are not needed, the patient (i.e., consumer) feels as if their time was wasted and they were denied the product they expected. We need to educate the public and change their expectations when it comes to antibiotic use.
- Judy Guzman-Cottrill, DO; Professor of Pediatric Infectious Diseases at OHSU
I think that one of the biggest challenges related to antibiotic use and stewardship is communication! From providing unsolicited feedback to a colleague, to discussing antibiotic appeals from patients, these are difficult conversations that occur in complex behavioral frameworks. Social, psychological, organizational, and cultural dynamics affect how one approaches antibiotic use. It is critical to build a safe learning environment that normalizes discussion of mistakes, encourages curiosity, and recognizes the contributions and perspectives of all team members.
- Jeremy Tigh, PharmD, BCIDP, Antimicrobial Stewardship Pharmacist, Samaritan Health Services
One of the most significant challenges to antibiotic use and stewardship is in long-term care settings. Residents living in long-term care settings are some of the most vulnerable to acquiring drug-resistant germs. Most of these settings don't have the same resources available for antibiotic stewardship that hospitals have. This can make it more difficult to monitor antibiotic use, and also to only use those medications when they are really needed.
- Therese Phin, RN, CIC, LTC-CIP, MDRO Infection Preventionist at Oregon Health Authority
For many years, doctors and the general public underappreciated the downsides of using antibiotics when they aren't needed – the full impact of harms to not only the patient but also society weren't well understood. Now that we have a much better handle on these harms, it's important that doctors and patients understand them.
- Christopher Pfeiffer, MD, MHS. Section Chief and Hospital Epidemiologist, VA Portland Health Care System, Medical Director of the Oregon's “DROP-CRE" Network
One of the challenges is trusting the microbiologic and pharmacokinetic data and avoiding overtreatment because of fear or worry. We may think we are helping by giving lots of antibiotics for a longer period of time when someone is sick, but in fact, that may be the more harmful thing to do.
- Amy Dechet, MD, Infectious Diseases Physician, Faculty of Internal Medicine Residency Program at Portland Providence Medical Center
Antibiotic and antifungal drugs are widely used in nearly all settings and specialties of human medicine, but also in veterinary medicine, and agriculture. Successfully addressing antibiotic resistance requires a One Health approach and collaboration across industries that aren't necessarily used to working together.
- Liz Breitenstein, PharmD, Antimicrobial Stewardship Pharmacist at Oregon Health Authority
Antibiotics are the only group of medications where the use in one person (or one animal) impacts how well that antibiotic might work in other people or how well it might work for that same person in the future. Because of this, the selection of antibiotic therapy is complex and requires prescribers to have current knowledge of the antibiotic-resistant threats they may encounter. Still, the biggest challenge to appropriate antibiotic use is knowledge. The general US public is not taught a lot about infectious diseases and antibiotics in school—despite the fact that EVERYONE is impacted by infections. This leads to misconceptions that contribute to the overuse and misuse of antibiotics in healthcare, agriculture, and the community. Learning more about antibiotic resistance would empower people to have conversations with their doctor and make decisions that ensure that they can appropriately care for their infections now and in the future.
- Jessina C McGregor, PhD, Professor, Oregon State University College of Pharmacy
From an antibiotic use standpoint, the biggest barriers are staffing resources and not having a robust EMR (electronic medical record) system in place to monitor drug therapy. An optimized EMR can be the difference between night and day as many tools can be utilized to prevent over-prescribing of certain drugs and readily obtain reports on current and historic prescribing.
- Danielle Britt, PharmD, MA, Infectious Diseases Pharmacist, Salem Health Hospital