Leading the Charge to Address Antimicrobial Stewardship in Alabama

Antibiotics play a vital role in the health care system, but antibiotic resistance is a growing problem, particularly in Alabama. The Harrison College of Pharmacy’s Dr. Spencer Durham is currently working with the Alabama Department of Public Health (ADPH) to learn more about these problems and improve health outcomes for those in the state and beyond.

Supported by a three-year, $750,000 grant from the ADPH, Durham has been working on the project titled “Improving Antimicrobial Stewardship Across Alabama,” to address the issue.

At the core of the project is antimicrobial stewardship, the practice of using antimicrobial agents, such as antibiotics, antifungals and antivirals, in the most effective way possible. This means selecting the best antibiotic that will result in the most optimal outcome for the patient while simultaneously minimizing the development of antimicrobial resistance and adverse effects for the patient.

“The provision of antimicrobial stewardship is complex and involves many different facets,” said Durham.  “Most of the time, a heavy emphasis is placed on antimicrobial stewardship of bacterial infections because there tends to be higher resistance of these organisms, but antiviral and antifungal stewardship is very important as well.”
Antimicrobials are very common therapeutic agents for familiar diseases or conditions. Whether it is bacterial diseases treated with antibiotics, viral diseases with antivirals, or fungal diseases with antifungals, antimicrobials are a regular and important part of our health care system.

The problem occurs when antibiotics are prescribed for diseases where they are not necessary, such as in viral infections. Seeking an antibiotic when you have a chest cold may seem like a good treatment, but is actually exposing bacteria already in the body to the antibiotic unnecessarily since there is no bacterial infection to treat.

“In general, when the microorganisms that are already in the body are exposed repeatedly to antibiotics, the organisms will develop ways to overcome the antibiotics,” said Durham. “In other words, the bacteria learn how to not be affected by the antibiotics and this is particularly problematic when using antibiotics that cover a wide range of organisms, which we generally call ‘broad-spectrum’ antibiotics, because more organisms can figure out how to become resistant.”

It becomes doubly problematic when these organisms that have built a resistance are passed to others and cause infection. Antimicrobial stewardship focuses on using antibiotics only when necessary and avoiding broad-spectrum options to reduce antibiotic resistance.

In Alabama, this has become a particular problem as the state has high incidences of the two most common factors that contribute to antimicrobial resistance: using antibiotics when they are not needed and overusing broad-spectrum antibiotics.

Unnecessary use is common with upper respiratory infection treatment, while use of broad-spectrum antibiotics includes the treatment of conditions like urinary tract infections. Some of the common broad-spectrum antibiotics used are fluoroquinolones, like Cipro and Levaquin.

“Most of the organisms that cause UTIs can be treated with more narrow-spectrum antibiotics,” said Durham. “Because these drugs have been so overused to treat UTIs, many bacteria that cause UTIs are now resistant to these antibiotics.”

While investigating the issues, Durham has worked with a number of health systems and long-term care facilities to analyze their prescribing practices and examine the antibiotic resistance within their institutions. With this data, he has identified patterns of use for certain antibiotics that contribute to increased resistance within the institutions.

“I have also consulted with pharmacists and other health care providers at other facilities to help them identify ways to restrict the use of broad-spectrum antibiotics, which has helped to improve resistance within their facilities,” said Durham.

To address the growing problem, Durham is continuing to work with a variety of facilities and health care professional groups to develop protocols and guidance on the use of antimicrobials while taking into account resistance patterns within their facilities.

He is also providing direct education to health care providers through programs such as the Alabama Infectious Diseases Society Annual Meeting, as well as developing continuing education courses for a variety of health care professions and creating a repository of information that will be available online for health care professionals
about antimicrobial stewardship.

“The best solutions to combat antimicrobial resistance are to only use antibiotics when necessary and reduce the use of unnecessary broad-spectrum antibiotics,” said Durham. “My ultimate goal is to help others use antibiotics more judiciously.”