Treating Wisely

Abstract

Antibiotic resistance continues to receive national attention as a leading public health threat. In 2015, President Barack Obama proposed a National Action Plan to Combat Antibiotic-Resistant Bacteria to curb the rise of “superbugs,” bacteria resistant to antibiotics of last resort. Whereas many antibiotics are prescribed appropriately to treat infections, there continue to be a large number of inappropriately prescribed antibiotics. Although much of the national attention with regards to stewardship has focused on primary care providers, there is a significant opportunity for surgeons to embrace this national imperative and improve our practices. Local quality improvement efforts suggest that antibiotic misuse for surgical disease is common. Opportunities exist as part of day-to-day surgical care as well as through surgeons' interactions with nonsurgeon colleagues and policy experts. This article discusses the scope of the antibiotic misuse in surgery for surgical patients, and provides immediate practice improvements and also advocacy efforts surgeons can take to address the threat. We believe that surgical antibiotic prescribing patterns frequently do not adhere to evidence-based practices; surgeons are in a position to mitigate their ill effects; and antibiotic stewardship should be a part of every surgeons' practice.

Misuse of Discharge Antimicrobial Prescription in the Emergency Department: An Observational Study at a Tertiary Care Center

“…Moreover, awareness about antimicrobial agents among surgeons appeared to be lower [13]. However, it is worth noting that awareness about appropriate antimicrobial use among the surgical subspecialties in the era of antimicrobial stewardship is on the rise [14].…”

Opportunities for system level improvement in antibiotic use across the surgical pathway

“…The responsibility for antibiotic prescribing in surgical teams is dispersed and the optimization of antibiotic therapy is often not prioritized. This leads to inappropriate antibiotic use with a prolonged duration (Leeds et al, 2016) (Table 1). This prevalent culture surrounding antibiotic decision-making in surgery needs to be understood and the expectation of surgical teams in relation to stewardship should be adjusted in view of this culture.…”

“…The overwhelming majority of surgical procedures require effectively limited delivery of antibiotic prophylaxis to prevent infections (Boucher et al, 2009;Bratzler et al, 2013). Evidence from around the world indicates that antibiotics for surgical prophylaxis are administered ineffectively, or are extended for an inappropriate duration of time postoperatively (Leeds et al, 2016;Tan et al, 2006). Ineffective antibiotic prophylaxis can contribute to the development of surgical site infections (SSIs), which represent a significant global burden of disease.…”

A Significant Question in Cancer Risk and Therapy: Are Antibiotics Positive or Negative Effectors? Current Answers and Possible Alternatives

“…The significance of this issue is highlighted by (a) the over-exposure of humans to antibiotics through self-medication or by sharing prescriptions with friends or relatives in many communities, regions and countries where antibiotics can be accessed without prescription [ 99 ], a societal problem that can be easily solved with appropriate guidance [ 100 ]; and (b) by misguided indication and inappropriate dosing schemes prescribed by physicians and medical institutions [ 101 , 102 ] for the treatment of clinical cases not even involving bacterial infections, in many cases to simply satisfy the demands of patients to be prescribed “anything” to sense that they are adequately taken care of. In addition to these instances of uninformed, unnecessary, unjustified and inadequate antibiotic use that still make us question the safety of antibiotics in the 21st century [ 103 , 104 ], cancer patients are being exposed frequently to antibiotics as prophylactic or therapeutic components of their anticancer treatment protocols, particularly during postoperative periods after surgery [ 105 , 106 , 107 ] as well as while patients are immunosuppressed by the action of chemotherapeutic drugs [ 108 , 109 ]. In addition, it is possible that, either through their own direct carcinogenic action or by indirectly modifying the microbiota, antibiotic exposure may alter the response of cancer patients to therapy by lowering its effectiveness, thereby resulting in the appearance of secondary cancers, the progression to advanced stages, including metastasis or tumor recurrence.…”