This study aimed to reduce the duration of antibiotics prescribed to children with uncomplicated skin and skin structure infections. Uncomplicated skin and skin structure infections, or uSSTIs, usually are treated with antibiotic therapy and include simple abscesses, cellulitis, impetiginous lesions, and furuncles. Complicated skin structure and skin structure infections (cSSTIs) affect deeper skin or are considered complicated in an immune-deficient patient. These include major abscesses, infected burns and ulcers, other infected wounds, and diabetic foot infections. The guidelines from Infectious Diseases Society of America for the management of SSTIS suggest a 5 day course of antibiotic treatment for uSSTIs, and can be extended if improvement is not made. The short antibiotic courses can help prevent antibiotic resistant bacteria from forming, lower costs, and reduce adverse effects. This study took place at the Cincinnati Children’s Hospital Medical Center, and aimed to increase short course antibiotic treatment (less than 7 days) in patients who came in with uSSTIs, compared to the previously used long-course therapy which lasts 7 to 14 days. At the beginning of this study 23% of patients with uSSTIs were prescribed short course antibiotic treatment.
To accomplish the study’s goal, they used a few methods. First, they had two 15-minute information sessions with residents and attendants. They also attached information cards about optimal antibiotic regimens for SSTIs to medical personnel’s identification badges. Pharmacists identified the third intervention as part of a multidisciplinary team, who noted that the order set default for uSSTIs was a 14-day course of therapy. The last intervention method was having a team member from the study contacting the physicians attending to SSTI patients and reiterating that short term antibiotic therapies can be used for uSSTIs, and to contact them with any questions. 5 months after the project began, 74% of patients with uSSTIs were discharged with the short term antibiotic therapies, and there was no significant difference in the amount of readmissions or recurrence for those who received the short term antibiotic treatment.
I really thought that this article showed the importance of pharmacists as part of a healthcare team, and how pharmacists can contribute innovative practices to medication changes. While changing the automatic duration of therapy in the prescribing system may seem simple, it can remind and alert the physician about the benefits of short term antibiotics and lead to less human error and increased savings. Also, this was the first time I had heard about short-term antibiotic regimens. While at first it seemed a little strange to me since I’ve been taught a lot about the importance of finishing antibiotic treatments to avoid resistance, it makes sense that shorter term antibiotic regimens would lead to increased patient adherence. Do you think that any of these methods could be implemented into a community pharmacy setting? Could pharmacists have played a more important role in this study, perhaps by educating pharmacists as well so that they can perform interventions when filling out prescriptions?
Citation: Schuler CL, Courter JD, Conneely SE, et al. Decreasing Duration of Antibiotic Prescribing for Uncomplicated Skin and Soft Tissue Infections. Pediatrics. doi: 10.1542/peds.2015-1223 (published 18 January 2016).