By Samuel Wilk and Alysse Wurcel, MD, MS
Antimicrobial resistance – born from widespread overprescribing of antibiotics – is a global threat, becoming an increasingly common cause of hospitalization and death. People who are incarcerated have higher rates of several bacterial infections, including cellulitis, pneumonia, and dental infections, and those infections lead to high rates of antibiotic usage in jails and prisons.
Antibiotic stewardship is an approach aimed at decreasing the use of unnecessary antibiotics. Until recently, most clinical providers believed prescribing antibiotics to be the safest and most effective way to treat many common infections. However, antibiotics are not without risks: each has various side effects ranging from nausea and vomiting to bone marrow suppression, as well as risks for secondary infections.
Decreasing antibiotic use has several benefits besides slowing antimicrobial resistance; the most direct is lowering the risk of side effects. Shorter antibiotic courses have lower risks for nausea, fever, diarrhea, and more serious complications.
Shorter courses are also less expensive, saving money without compromising outcomes. By staying up to date on prescription practices and guidelines, carceral health care systems could save millions of dollars. And from a staffing point of view, decreasing antibiotics cuts down on the amount of time staff members are on the cellblocks passing the medications.
The “Shorter Is Better” movement – a term coined and pioneered by Brad Spellberg, MD, Los Angeles General Medical Center’s chief medical officer – advises providers to prescribe short-course antibiotics when clinically appropriate. There are more than 100 trials showing that shorter courses of antibiotics are just as good as long courses in treating certain infections. For those studied infections, the research shows that fewer days of treatment provide equal rates of cure, with lower likelihoods of adverse effects, secondary infections, and bacterial resistance – the key outcomes that the global antimicrobial stewardship movement hopes to achieve.
It is important to note that not everything can be treated with less antibiotics. Prosthetic joint infections, for example, need the full 12-week course – six weeks just won’t cut it. And antibiotics aren’t inherently bad; they save lives every day. We are certainly not suggesting that we need to cut down on all antibiotic use. But health care systems – of any type – should be using the best, most up-to-date evidence possible to determine protocols for antimicrobial prescriptions. Antibiotic use has significant costs, both financially and to our health, and overuse must be taken seriously.
Antimicrobial stewardship teams are a key step in this direction. Becoming more and more established in community and academic medicine, these teams guide prescribing practices that prevent the development of drug-resistant pathogens.
The next step in this movement is to encourage jails and prisons to review their antibiotics usage and identify opportunities to safely decrease antibiotic prescriptions. The ultimate goal is to treat infections with the shortest and safest course of antibiotics possible.
Samuel Wilk is a medical student at Tufts University School of Medicine. Alysse Wurcel, MD, MS, is an infectious disease specialist at Boston Medical Center.
For More Information
bradspellberg.com/shorter-is-better
