In recent public controversies over the use of vaccines to prevent serious, communicable illnesses, one fact that became clear is that the human body has a love-hate relationship with bacteria, and maintaining a balance of the right organisms in the population at large is both complicated and crucial.
As detailed in a new Business Report feature, the challenge is one that public health officials in Louisiana and around the world struggle with daily: ensuring the availability of disease-fighting bacteria that can prevent widespread illness, while restraining the use of the antibiotics to preserve their effectiveness.
The Centers for Disease Control has launched a concerted efforts to reduce the overuse of antibiotics, in hopes of preserving their usefulness for longer periods. The CDC developed models for antibiotic “stewardship” programs that since have been integrated into standards hospitals must meet to renew their accreditation.
The result has been that there is “far more interest in trying to get a handle on antibiotic use in the inpatient setting than there was 10 years ago,” says Dr. Julio Figueroa, an associate professor of clinical medicine and a specialist in infectious diseases at LSU Health School of Medicine.
Figueroa says LSU had developed a stewardship program encompassing all the hospitals in its system before the governor privatized those institutions last year. Now LSU partners with private hospitals throughout the state to improve antibiotic management.
The stewardship programs focus on getting primary care physicians who take care of patients in the hospital to agree on more judicious policies relative to antibiotic use.
Figueroa says one obstacle is the inclination of doctors to treat an infection—or supposed infection—using a broad-spectrum antibiotic.
“Diagnostic uncertainty” is a big driver, he says, noting that a physician may not know for sure what is making a patient sick, but may think, “If I don’t give the patient an antibiotic, they may have a bad outcome or they may sue me.”
Patients with flu-like symptoms are a good example, he says. It’s not unusual for a patient to push a doctor to prescribe an antibiotic, even though “real” flu is a virus and therefore not affected by bacterial antibodies.
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