Antibiotic Prescribing Limited in Healthcare Facilities

The LDA posted comments on antibiotic stewardship program . You can go to the government website and see our comments. 

https://www.regulations.gov/document?D=CMS-2016-0095-0114  or click here for pdf of our letter

Citing the increase in drug resistant bacteria, the Centers for Disease Control has been leading an effort with the “National Quality Forum’s National Quality Partners which convened more than 25 expert and national stakeholders from the public and private sectors—including patient advocates, infectious disease physicians and pharmacists, and acute care providers—to develop National Quality Partners Playbook: Antibiotic Stewardship in Acute Care,” published in May 2016. The IDSA, which has been instrumental in providing Lyme treatment guidelines which limit antibiotic treatment for Lyme patients, was on the above panel.

https://www.qualityforum.org/Publications/2016/05/Antibiotic_Stewardship_Playbook.aspx

The Playbook will be used to help hospitals and health care systems implement antibiotic stewardship programs and is based on CDC’s Core Elements of Hospital Antibiotic Stewardship Program.

According to John G. Bartlett, MD, in a press release on Medscape Infectious Diseases, July 14, “the CDC has responded with a comprehensive program designed to facilitate the smart use of antibiotics, slow resistance, and improve patient care. All healthcare facilities that receive funding from the Centers for Medicare & Medicaid Services (CMS) will be required to participate in the program, so all healthcare providers who prescribe antibiotics within these facilities will likely be affected.”

https://www.medscape.com/viewarticle/865893

Further information provided by the Office of Congressman Christopher Smith (NJ-4):

Here is the CMS rule proposal announcement and here is the full proposal. The proposal, which relates to a number of aspects, includes requirements that hospitals and critical access hospitals (CAHs) must meet to participate in Medicare and Medicaid. The proposed changes to the requirements, formally called the Conditions of Participation, would “modernize and revise the requirements to reflect current standards of practice and support improvements in quality of”, including by  

“Improving the use of antibiotics (including the potential for reduced antibiotic resistance)”.

While this rule would address many other aspects as well, under the proposed rule, hospitals and CAHs would be required to:

• “Have hospital-wide infection prevention and control and antibiotic stewardship programs for the surveillance, prevention, and control of healthcare-associated infections and other infectious diseases, and for the appropriate use of antibiotics”.

“The Joint Commission, a 501© that accredits and certifies heath care organizations has also released its own Antimicrobial Stewardship Standard which can be found HERE for hospitals and critical access hospitals.” 

The proposal was released on June 13, 2016 and there is a 60 day public comment period.

The LDA wonders why during consideration of these new requirements, no mention seems to be made about the fact that according to the Union of Concerned Scientists, 70% of antibiotics and related drugs used in the US are used for agricultural use, and this use deserves special attention, “since they provide resistant bacteria with a direct route into people’s kitchens.” The Union also says, “While the links between animal agriculture and human disease are complicated and in need of additional study, evidence is strong enough for scientists and public health organizations to call for reduced use of antibiotics in agriculture. The CDC has concluded that, in the United States, antimicrobial use in food animals is the dominant source of antibiotic resistance among foodborne pathogens [emphasis added]….. Obvious nonessential uses, such as nontherapeutic use in livestock operations, should be the first target in the effort to save antibiotics. The CDC and the World Health Organization have called for an end to the nontherapeutic use in animals of drugs that are used to treat human disease or that are related to such medicines. “

The problem according to UCS is “Eliminating this use of antibiotics challenges the standard operating procedures of a large and powerful industry.” So money and power again triumph over the health of patients, both by letting these industries dump unchecked massive amounts of antibiotics in healthy cattle, pig and chicken feed to get faster weight gain, and by the government again letting vested interest interfere in patient healthcare by limiting antibiotic use by sick people.

No doubt resistance is a problem, but government should be prioritizing the imposition of restrictions to an area where the problem involves the largest percentage of antibiotic misuse, fattening healthy animals for the sake of greed, as opposed to a much smaller area of use for sick humans.