Guest: Dr. Aaron E. Glatt
Presenter: Neal Howard
Guest Bio: Dr. Aaron E. Glatt, spokesperson for the Infectious Disease Society of America and chair of the Department of Medicine at South Nassau Communities Hospital, is the author of 200 scientific journal articles and presentations at national meetings and an internationally known medical lecturer. His medical interests also include general infectious diseases, infection control,Clostridium difficile, tuberculosis, fungal infection, occupational-related HIV seroconversion, HIV infection, and antibiotic utilization.

Segment overview: In this segment, Dr. Glatt discusses the key to ensuring and safeguarding the effectiveness of antibiotics. When to prescribe them, when not to prescribe them and what is the dosage to prescribe that is commensurate with the infection.

Transcription
Health Professional Radio – Beneficial Health Use of Antibiotics

Neal Howard: Hello and welcome to Health Professional Radio. I’m your host Neal Howard, thank you so much for joining us today. While antibiotics are lifesaving drugs, they aren’t without some risk, the most common cause of emergency department visits for adverse drug events is in the case of antibiotics. And every year about two million people or so become infected with bacteria that are resistant antibiotics. Our guest in studio is Dr. Aaron E. Glatt, spokesperson for the Infectious Disease Society of America and also Chair of the Department of Medicine at South Nassau Communities Hospital and he’s here today to speak with us about efforts to improve the use of antibiotics. How are you this afternoon doctor?

Dr.Aaron Glatt: I’m fine, thank you for having me to discuss in this very important question.

N: Thank you for joining us. Now I understand that there’s an effort to raise awareness in that there’s an Antibiotic Awareness Week in an effort to raise awareness about the beneficial use of antibiotics. I understand that it’s an awareness effort that is ongoing, talk about some of the problems associated with these lifesaving drugs?

G: Sure, so antibiotics are God sent. They really are lifesaving and had tremendous benefits for many people with serious infections. However, antibiotics are too exhort and that’s what the Centers of Disease Control and Prevention has declared an Antibiotic Awareness Week and it’s not that’s just one week, so if you missed it you’re okay because it’s a continuous 52 week a year type of an effort that’s incumbent upon physicians as well as all the healthcare practitioners as well as patients to understand how and why we want to use antibiotics properly and to save this tremendous tool in our medical armamentarium so we can continue to save patients’ lives and not having to be in a situation or in a post antibiotic era where we don’t have the ability to treat infections. Antibiotics are very valuable tools to treat certain infections, specifically serious bacterial infections to the most part. Unfortunately antibiotics are imperfect and antibiotics can have a tremendous amounts of side effects associated with them from the drug itself, but they can also have impact on society by changing the resistance patterns. When you get exposed to an antibiotic, the bacteria in your body and the bacteria that have been exposed to that antibiotic are potentially impacted in a positive or negative way. If you eradicate the infection that’s wonderful, but if you’re unfortunately cause resistance to develop so then what you’ve done is actually made things worse in some ways and then if the patient then gets infected or transfers that antibiotic resistant bacteria to another patient, when they get sick they can be much more seriously impacted and you may not have an antibiotic to treat them with. This is the development of antibiotic resistance that has been increasing and worsening over the years. In addition, you now have inability to treat some of these infections as an outpatient, you can’t keep them orally in an antibiotic framework and instead you have to bring them to a hospital and gave them intravenous antibiotics where you can give the intravenous antibiotics outside the hospital, you’ve up the …, you’ve made that much more difficult to treat these infections and the course is not insignificant.

N: Now Doctor I’m going to ask in your opinion and in your experience, which factor is the most heaviest contributing factor to this resistance to antibiotics? Is it the patient’s physiology based on taking antibiotics over the years and their physiology becoming more resistant to what the antibiotics can do? Is it the infection itself or is there something going on in the pharmaceutical industry that has to do with these ineffective antibiotic treatment?

G: So when Fleming discovered penicillin and then in 1945 he accepted the noble prize to this, he mentioned already them that antibiotics are not perfect, and antibiotics can have the resistance developed to them. And it’s a multifactorial in many, many reasons why bacteria become resistant, but the major problem I would say to answer your question, the major problem right now, is inappropriate antibiotic usage. When a person has a cold and they come to the doctor and the doctor prescribes them an antibiotic for various reasons, when it will have zero benefit and only potential toxicity and unfortunately a very significant percentage of patients who are prescribed antibiotics are being prescribed them inappropriately. Antibiotics do nothing for the cold, antibiotics do nothing for most cases of upper respiratory infections and bronchitis and sinusitis – these are very frequently prescribed reasons for antibiotics. Antibiotics are very, very important treating through urinary tract infections that many, many patients are given antibiotics who don’t have urinary tract infection. Patients demand antibiotics or else they’ll go to a different doctor. Patients think mistakenly that taking antibiotics they have from a previous visit that they still have in their medicine chest are still good and are appropriate for the next time they have any sort of the problem. So the major issue that we have today in terms of antibiotics uses in the United States is inappropriate antibiotic usage. If you eliminated that, you would solve a tremendous amount of the problems that we have with antibiotics.

N: Talking about eliminating the improper use and I guess improper prescribing of antibiotics, we kind of look to our health care providers to tell us what to do and none of us are doctors. Why do you think that it is that a physician would go ahead and prescribe antibiotics based on the desire of a patient who’s not a doctor and has no training in how antibiotics work and how they affect the body based on what infection you have?

G: That’s a very good question and I wish I had a very good answer for you. A lot of it education, physicians need to be re-educated as to the importance of properly prescribing antibiotics. And patients do sometimes put a hard cell on a physician saying, “No, I know I need an antibiotic. The last time I had an antibiotic. The other doctor gave me antibiotic and it worked.” And the physicians can sometimes unfortunately giving into that peer pressure and in part is not themselves convinced that the patient is wrong. The bottom line is, certain infections there’s tremendously hard strong evidence that those infections will not be benefited by any antibiotic and in fact antibiotic will make the patient worse, not better. The educational message that we have to get across better to physicians.

N: Speaking of education both for the physicians and the patients, is there any existence at least that correspond and says, “Okay this condition calls for this antibiotic. This condition calls for that antibiotic and so on and so on.” So that there’s cut and dried guide when someone comes in who’s probably been brainwashed by the commercials that we’re given, none of us can buy this products we can only go to our physician’s yet they’re advertising to us?

G: Right, it’s not as cut and dried as you said but to a certain extent there are all recommendations and guidelines put out by Infected Disease Society of America as well as other very important and impressive societies that do recommend for certain indications, certain prescriptions be prescribed. However, much more importantly is the indications where it’s not indicated. The patient who has a cold, has a viral illness, that’s probably the number 1 reason why antibiotics are prescribed and it does absolutely nothing to shorten the duration of therapy or to prevent them. Many times patients and physicians liking by giving this will prevent a more serious problem. What they’re in fact doing is not preventing anything from occurring but they are guaranteeing that if an infection does occur, there’s an excellent chance they’ll be resistant to the antibiotic that was prescribed. Plus there’s the toxicity and plus the very insidious disease after called ‘C-difficile,’ which is actually in affects that you get because you took antibiotics. And the antibiotics actually spur or allow that infection to occur and we’re seeing more and more of this infection and we’re seeing more and more serious complications from the c-difficile. So one of the major reasons not to give this appropriate antibiotics is that the actually can cause or stimulate your body to get this infection.

N: What steps, other than the obvious as far as Antibiotic Awareness Week and other efforts, what steps is the CDC and other organizations taking in order to give this information to our potential physicians, those that are entering medical school, those are in their residency? What’s being done to get this information out there so that we don’t have this misuse of antibiotics that are so beneficial when properly used?

G: Sure that’s a great question, and the Government has actually mandated as of January 2017 that every single hospital have a fully functioning … stewardship program which essentially states every hospital has to figure out a plan how to appropriately use antibiotics in their hospitals. So for example, at our hospital at South Nassau Communities Hospital, we have a very robust and a very strong program in place now for many years. And we’ve been constantly increasing its vigilance and its surveillance and its oversight to guide and educate physicians in the proper usage of antibiotics and we’ve been extremely successful and as a result we’ve seen tremendous decreases in some of the complications here at South Nassau of some of these infections like c-difficile. And that is what every hospital needs to do, to put together a robust, educational as well as guidance program in place for young physicians as well as for more experience physicians to remind them, “this is appropriate, this is not appropriate.” And also stopping the antibiotics when it’s no longer appropriate, it may be appropriate at day 1 but when you have more information on day 3 or day 5 or day 7 that initial correct antibiotic may no longer be necessary. So appropriate durations of therapy, appropriate roots of therapy, appropriate what we call de-escalation of therapy downgrading from a broader agent to a more specific agent – this and many other tactics are essential in making sure that we use antibiotics appropriately and it’s in South Nassau for example we’re way ahead of the curve.

N: Now where can our listeners go and get more information about how antibiotics should be used?

G: They can go to our website certainly and we have a number of videos that are geared for patients to understand how antibiotics are properly used and that … hospitals website. They can certainly go to Descendants of Disease Control and Prevention websites, the CDC’s website as well the Department of Health website for whatever state they may be in.

N: It’s been a pleasure talking with you this morning, thank you so much for coming in.

G: It’s absolutely my pleasure and thank you for raising this very important subject.

N: You’ve been listening to Health Professional Radio, I’m you host Neal Howard, in studio with Dr. Glatt. And we’ve been talking about the proper use and in the improper use of antibiotics. Transcripts and audio of this program are available at healthprofessionalradio.com.au and also at hpr.fm, and you can subscribe to this podcast on iTunes.

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