Find
out more about the broad range of issues associated with
antimicrobial resistance
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Find
out about the Division of Healthcare Quality Promotion's campaign
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Frequently
Asked Questions
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Here you can find general information about antibiotic resistance
and how to prevent it.You will also find helpful information about
colds, the flu, and other illnesses.
Go
to the FAQ Section
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Continuing
Education Course
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Background
on Antibiotic Resistance
Antibiotics, also known as antimicrobial drugs, are drugs
that fight infections caused by bacteria. After their discovery in the
1940's they transformed medical care and dramatically reduced illness
and death from infectious diseases. However, over the decades the bacteria
that antibiotics control have developed resistance to these drugs. Today,
virtually all important bacterial infections in the United States and
throughout the world are becoming resistant. For this reason, antibiotic
resistance is among CDC's top concerns.
Antibiotic resistance has been called one of the world's most
pressing public health problems.
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Antibiotic resistance can cause significant danger and suffering for
children and adults who have common infections, once easily treatable
with antibiotics.
Antibiotic Resistance-
what it is and how it happens:
Antibiotic use promotes development of antibiotic-resistant
bacteria. Antibiotic resistance occurs when bacteria change in some way
that reduces or eliminates the effectiveness of drugs, chemicals, or other
agents designed to cure or prevent infections. The bacteria survive and
continue to multiply causing more harm. Widespread use of antibiotics
promotes the spread of antibiotic resistance. While antibiotics should
be used to treat bacterial infections, they are not effective against
viral infections like the common cold, most sore throats, and the flu.
Antibiotics kill bacteria, not viruses
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Smart use of antibiotics is the key to controlling the spread of resistance.
What does CDC recommend?
Only use antibiotics when they are likely to be
beneficial.
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By visiting this website you are taking the first step to reducing your
risk of getting antibiotic-resistant infections. It is important to understand
that, although they are very useful drugs, antibiotics designed for bacterial
infections are not useful for viral infections such as a cold, cough,
or flu.
How can you prevent antibiotic-resistant infections?
- Talk with your health care provider about antibiotic resistance.
- Ask whether an antibiotic is likely to be beneficial for your
illness.
- Ask what else you can do to feel better sooner.
- Do not take an antibiotic for a viral infection like a cold or the
flu.
- Do not save some of your antibiotic for the next time you get sick.
- Take an antibiotic exactly as the doctor tells you.
- Do not take an antibiotic that is prescribed for someone else.
Our
Campaign
Tackling Antibiotic Resistance:
Overuse of antibiotics is jeopardizing the usefulness of essential drugs.
Decreasing inappropriate antibiotic use is the best way to control resistance.
In 1995, the Centers for Disease Control and Prevention (CDC) launched
a national campaign to reduce antimicrobial resistance through promotion
of more appropriate antibiotic use.
Recommendations for appropriate antibiotic
use for health care providers:
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CDC's National Campaign:
CDC's National Campaign for Appropriate Antibiotic Use has two OBJECTIVES:
- Reduce inappropriate antibiotic use
- Reduce the spread of resistance to antibiotics
To accomplish these objectives, the campaign
uses the following approaches:
- Developing strategies and materials that will lead to changes in antibiotic
use.
- Serving as a resource to groups undertaking their own campaigns.
- Forming partnerships to harness the resources of collaborating organizations.
- Assessing impact on antibiotic use, resistance, and patient/physician
satisfaction.
Current campaign activities include:
- Developing and distributing educational materials
promoting appropriate antibiotic use
- Funding states to develop, implement
and evaluate local campaigns
- Evaluating and promoting a medical school curriculum
on appropriate use of antibiotics
- Continuing to develop and test a Health Plan Employer Data and Information
Set (HEDIS) measures for appropriate antibiotic
use
- Implementing a national advertising campaign
promoting the appropriate use of antibiotics
Several new
activities are on the horizon for this National Campaign. In an effort
to expand the reach and scope of our program we are adding these new
activities. |
Medical School Curriculum
In 1999, Division of Bacterial & Mycotic Diseases
(DBMD) and Division of Healthcare Quality Promotion (DHQP) contracted
with WESTAT and the University of California, San Diego for the
development of a curriculum to teach medical students about the
appropriate use of antibiotics in hospital and outpatient settings.
The curriculum is part of a larger curriculum for fourth year medical
students that teaches concepts from basic science in the context
of clinical care. The antibiotic use curriculum is built around
activities promoting prudent decision-making about antibiotic use.
The curriculum is delivered in three formats to maximize
learning: large group lectures, small group discussions, and a web-based
computerized module. Lectures will cover topics such as: the extent
of the problem of antibiotic resistance, mechanisms of resistance,
principles of judicious use, diagnostic techniques, and appropriate
antibiotic treatment and prophylaxis.
Small group discussions use case-based learning and
give students the opportunity to learn from their peers and model
appropriate behaviors (e.g. talking with a patient about why antibiotics
may not be necessary). Discussions focus on control measures for
nosocomial infections, high-risk environments, patient education
scenarios, cases involving complex decision-making and questions
of ethics, and strategies to prevent recurring infections.
The web-based computerized module provides self-directed
learning opportunities to complement the material provided in the
lecture and small group settings. The computer module is case-based
with on-line resources and a pre- and post-test. In each of the
thirteen cases, the user selects a working-diagnosis, orders diagnostic
tests, and makes a decision about antibiotic use. If an antibiotic
is prescribed, the user determines the dose and duration of treatment.
For all the choices made, feedback is given including to what extent
the specific choices would contribute to emerging resistance to
antibiotics.
The evaluation of the curriculum included components
designed to evaluate the acceptability of the curriculum to students
as well as the acquisition of knowledge of the topics presented.
Results: The curriculum was pilot tested at six medical
schools identified by the Association of American Medical Colleges
(AAMC). Thirty students per school, composed of third-year and fourth-year
students, participated in the pilot tests. The faculty were infectious
disease faculty or fellows. The methods consisted of a pre-test,
lectures, small groups, Web cases, and post-test. The assessment
focused on acceptability of the materials, ability of the materials
to communicate the primary educational messages, and feasibility
of the implementation. Data used for the curriculum assessment consisted
of student pre- and post-test scores, student evaluation of lectures,
small groups, and Web cases, faculty assessment of the curriculum
content, and administrator assessment of the process. Overall, results
were positive for all areas of the curriculum and had significant
impact on student knowledge. Students gave close to perfect ratings
for the objectives, lecture organization, small group activities,
and web cases. Faculty and administrators also gave the curriculum
high marks.
During 2004, the curriculum will be promoted to medical
schools by the AAMC.
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National Media Campaign
The Respiratory Diseases Branch and the Division of
Bacterial and Mycotic Disease's Health Communication Department
launched a national media education campaign promoting appropriate
antibiotic use in the community for upper respiratory infections.
The target audiences of the education campaign are parents of young
children.
While there are many public and private organizations
promoting and subsidizing interventions for appropriate antibiotic
use, a strategic national approach to intervene in patient behavior
has not been attempted. Evaluation of past interventions has shown
that multifaceted campaigns geared towards increasing the public's
knowledge of antibiotic resistance, when combined with interventions
to improve provider prescribing behavior, have been effective in
reducing the misuse and overuse of antibiotics. Since public demand
plays an important role in the misuse and overuse of antibiotics,
mass media strategies are an appropriate means of reaching the target
audience and should help to increase knowledge and change attitudes
and behavior about taking antibiotics for viral upper respiratory
tract infections.
The media campaign was developed by Ogilvy Public
Relations Worldwide and consists of three phases. Phase I of the
campaign consisted of the development, production, and distribution
of print, radio, and television PSAs. These media were designed
and tested using formative research and focus groups. In June, as
part of the national conference on appropriate antibiotic use, media
kits were distributed to state partners and workshops were conducted
on the implementation of the kits for their respective campaigns.
Phase II consisted of a national launch and media
event on September 17, 2003 at the Interscience Conference on Antimicrobial
Agents and Chemotherapy in Chicago, IL. Phase III is currently underway
and will focus on establishing evaluation projects, expanding our
partners and methods of dissemination, and assessing the impact
of Phase II.
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HEDIS Measures
Although awareness of the consequences of inappropriate
antibiotic prescribing is increasing both among physicians and patients,
the practice remains widespread. One mechanism for highlighting
the importance of specific medical practices, such as appropriate
antibiotic use, is the public reporting of performance on selected
quality of care measures by managed care plans. The most widely
used system of performance measures, the Health Plan Employer Data
and Information Set (HEDIS), offers an excellent vehicle for raising
public awareness and improving medical practice.
In 1999, 410 health plans representing 52 million
members reported HEDIS results to the National Committee for Quality
Assurance. Because HEDIS did not contain any measures related to
the management of acute conditions, adding measures in the area
of appropriate use of antibiotics in children would improve the
measurement set. Previous attempts to develop such measures suffered
from insufficient testing of new measures prior to HEDIS inclusion
and have ultimately resulted in withdrawal of the measures.
For this project, experts in appropriate antibiotic
use collaborated with a multidisciplinary team of researchers with
expertise in the development and testing of HEDIS measures to develop
and test two measures of appropriate antibiotic use in children.
The objectives were to (1) Develop and test a performance measure
that examines antibiotic prescribing rates for URI in children and
adolescents and (2) Develop and test a performance measure that
examines Group A Strep (GAS) testing rates in children and adolescents
diagnosed with pharyngitis and prescribed an antibiotic. As a result
of the study, two measures were developed. They are Appropriate
Treatment for Children with URI and Appropriate Testing for Children
with Pharyngitis. Both measures have been approved for HEDIS
2004.
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Several other programs within the CDC address
the growing problem of antimicrobial resistance. You can find information
on specific programs at the following websites:
Scientific Support:
In 1998, a group from CDC, the American Academy of Pediatrics (AAP), and
the American Academy of Family Physicians (AAFP) drafted principles
of judicious antimicrobial use for pediatric upper respiratory infections
(Pediatrics 1998; 101:161-184).
This year, CDC collaborated with members of American College of Physicians-American
Society of Internal Medicine, AAFP, and the Infectious Diseases Society
of America to develop principles for appropriate
antimicrobial use for adult upper respiratory tract infections. These
were published in the March 23, 2001 edition of The Annals of Internal
Medicine and in the June 2001 edition of The Annals of Emergency
Medicine.
Medical Director for CDC's National
Campaign for Appropriate Antibiotic Use:
Richard Besser, M.D.
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"The biggest problem is inappropriate
prescribing of antibiotics. Tens of millions of antibiotics
prescribed in doctor's offices are for viral infections, which
are not treatable with antibiotics. There are many reason's
for this, including demand from patients, time pressure on physicians,
and diagnostic uncertainty. The patient wants to get back to
work or get the child back to school, and the doctor wants the
patient to feel satisfied with treatment. The result is over-prescribing
of antibiotics, resulting in the development of resistant bacteria.
The best way to combat this practice is to educate the physicians
and the public to decrease both demand and over prescribing
In addition, providing clinicians with better means of diagnosing
respiratory tract infections may remove some of the uncertainty
that promotes over prescribing." |
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Medical
Advice Disclaimer
- CDC's website provides health information for your general knowledge.
- Concerns about a medical condition--either your own or that of a family
member, should always be addressed to your primary care physician for
advice and care appropriate to your specific medical needs.
- CDC does not recommend self-diagnosis or self-management of health
problems that should be attended to by health care professionals.
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