Two Women at Johns Hopkins Are Reinventing How Antibiotics Are Used

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The news regarding antibiotic misuse is, needless to say, bleak. 

But, the work of Dr. Sara Cosgrove of Johns Hopkins School of Medicine is a ray of hope. And, the Agency for Healthcare Research and Quality (AHRQ) - an arm of the US Department of Health and Human Services - must agree with me as they just gave her $16 Million (a LOT of money for that governmental agency.) 

Dr. Cosgrove, an associate professor of medicine and epidemiology at Johns Hopkins University, is not interested in designing new antibiotics, or even antibiotic resistance so much. What she and her colleague, Dr. Pranita Tamma, are interested in is implementing change in the way that antibiotics are used in health care settings. They are focused on the front lines and how the health care community can make wide scale changes in order to preserve the antibiotics that we already have in our dwindling arsenal. 

Dr. Cosgrove thinks that we are at a pivotal moment in antibiotic overuse where we need to move towards a better understanding of antibiotics and, in turn, use them more wisely. And, the cause of concern is not just antibiotic resistance, although she admits that it goes hand in hand with overuse. But, there are other concerns such as infections that can arise (Clostridium dificile,) the perturbation of the microbiome, etc.

These health issues have been overlooked for a long time and highly underestimated while physicians hand out antibiotics like candy. Don't feel well? Try some cephalexin. Runny nose? How about some ciprofloxacin. Acne? How about clindimycin? Cream or pills - whichever you prefer. 

This misuse of antibiotics is finally being recognized as a major problem. To this end, there are increasing requirements in health care settings for 'academic stewardship' - a program in place where the use of antibiotics is monitored and improved.  In fact, with more attention being given to this issue, illustrating academic stewardship is becoming an increasing requirement for both accredidation and also reimbursement by Medicare (a cornerstone of health facility funding.)   

These emerging requirements have led to an availability of funds by the government to improve implementation strategies. And, Dr. Cosgrove and Dr. Tamma have a plan to use every penny of their $16M. 

The overall goal of their plan is to identify the problems of antibiotic use and correct them - shifting the paradigm of how antibiotics are used.

First and foremost, they want to create a program where communication between healthcare providers is paramount. The days when a physician would waltz in and drop a prescription without consulting anyone should be gone. The decision of whether to use an antibiotic and, if so, which one needs to be a broader decision. The nurse who is administering the drug may have a much deeper understanding of the side effects on a particular patient, a missed dose, or the state of IV access - all important information. The person hanging the IV should not be silent - especially if they may be the most knowledgeable person in the room.  

The project has several stages. The first is to review the evidence of what approaches have been successful and utilize those to develop the best plan. The project bites off more than others have in that they are analyzing the practices of three different settings (hospital, long term care, and ambulatory) whereas most studies to date have been done in only inpatient settings. The second phase will develop a giant toolkit that acts as a resource to train people in the best practices.

Although Dr. Cosgrove is creating a shift within a fully functioning health care center (like learning how to fly a plane while it's in the air) there needs to a parallel focus on the next generation of health care providers and that medical education needs to evolve with the changing times. 

But, this plan is not just to benefit the patients at Johns Hopkins. There are two (very large) intervention phases - or getting the program out into health care settings. There is a large pilot planned in 30 sites. After the pilot, they will pause to look closely at what worked, what didn't, and how to make improvements. They will fix the broken parts and role out an improved plan in up to 500 acute care centers, long term care centers and hospitals, all within a year of each other. 

Dr. Cosgrove understands that this project is a massive undertaking. But, she is nothing if not enthusiastic and hopeful, saying repeatedly that "it will happen" and you've "gotta start somewhere." 

There is amazing science being done in researchf labs across the world on the discovery of new antibiotics, but, that work is in vain if it does not get translated to the patients that need it. The science is required, but, we cannot just do the science without looking at what is going on by the hospital beds.

Dr. Cosgrove says it best when she states that we "must not forget the importance of taking the pearls from great researchers and using them to benefit the health of people in the country."