As more medical centers move towards vancomycin area under the curve (AUC) dosing, and away from trough based dosing, infectious disease specialist Aaron Hamby, PharmD, The Medical University of South Carolina Health, says he and his colleagues wanted to understand the indications for AUC-based dosing and monitoring.

They performed a retrospective chart review of all adult patients who received vancomycin in January 2021, three months post implementation of AUC-based dosing, and examined dosing and monitoring appropriateness and compliance of documentation.

“Analysis showed that 96% of iVents and 90% of progress notes were documented correctly,” Hamby et al wrote in their study. “Overall, AUC-based protocol was appropriately selected in 92% of the patients, but only followed through for 88%. Correct documentation was noted in 93% of the patients analyzed.”

The investigators concluded that the AUC-based vancomycin dosing and monitoring initiative was successful at their institution. They also identified opportunities for further education including defining which types of infections should utilize AUC-based monitoring and ensuring correct levels are ordered when AUC-based monitoring is utilized.

The study, “Evaluation of Vancomycin Area Under the Curve Monitoring at Large Academic Medical Center,” was presented at the 

24th Annual Making a Difference in Infectious Disease (MAD-ID) Meeting 2022

 spoke to Hamby at the MAD-ID meeting who provided more information about the study’s findings.

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A medical center wanted to review prescribing and documentation practices for their pharmacists. 

Monitoring Vancomycin Area Under the Curve Dosing 

 infections spike across the US once again, people are understandably concerned about the newest reports of zoonotic infection. About 300 cases of 

 have been reported in at least a dozen countries.

Although monkeypox is not new, the outbreaks are causing some concern due to their scope; monkeypox is typically endemic to central and western Africa, but most of the infected persons had not traveled to these regions.

Internationally recognized physician and scientist Peter Hotez, MD, PhD, sat down with 

to discuss these monkeypox infections that have captured the attention of both public health and the general public.

“It’s still a bit of a medical mystery,” Hotez said, “But the unusual feature is the multiplicity of outbreaks.” It remains unknown how and why monkeypox is spiking now, but Hotez said current theories include a centralized index of cases that may have emerged in the Canary Islands, or perhaps Berlin or Belgium.

Cases have now been identified in the US as well. Hotez said he understands there to be confirmed or suspected monkeypox infections “in Massachusetts, 1 in New York, 1 in Florida, and there are 2 now around the Salt Lake City, Utah area.”

“This is still a very uncommon illness,” Hotez emphasized. “The numbers are quite small.” Notably, however, monkeypox has an incubation period of 2 weeks. This means that we will likely see cases rise in the coming weeks, but “that’s not a cause for undue alarm.”

“I doubt that this will grow exponentially,” Hotez said. “And the reason I have that optimism is because there is that long incubation period, and the illness is associated with a characteristic rash, so it’s not as if there are a lot of asymptomatic illnesses.”

Hotez recalled the difficulty of doing contact tracing for COVID-19, when half the infections were asymptomatic and the incubation period was significantly shorter.

Additionally, monkeypox is a relative of 

, and thus we have “at least 2 vaccines” stockpiled by the US. We also have antiviral drugs available, and Hotez details the interesting history of how the fear of Russian biological warfare during the Cold War brought these drugs into existence.

“If we need to deploy vaccines or antiviral drugs in order to contain this outbreak, unlike COVID-19, we already have them on hand.”

It is still too early to know the full demographic profile of all those infected, but the US Centers for Disease Control and Prevention (CDC) and European health agencies have noted that outbreak clusters have appeared primarily in men who have sex with men. However, Hotez said, “We do not think at this point that it is a sexually transmitted virus, but rather it’s a virus that’s transmitted by close, face-to-face, personal contact.”

Hotez said it is likely a coincidence that the early individuals indexed for monkeypox were gay and bisexual men, who then may have spread it through their networks. “I think we have to be very careful not to stigmatize groups or individuals about this virus…our profession has made that mistake before.”

Common symptoms of monkeypox are fever, headache, backache, and swollen lymph nodes, which eventually devolve into a characteristic pustular rash. Infection can become serious, but Hotez noted that the monkeypox outbreaks across Europe and North America appear to belong to the west African and Nigerian strain, which is typically associated with lower mortalities.

So far, Hotez said, there have been no mortalities among those infected.

, is a professor of Pediatrics and Molecular Virology & Microbiology at Baylor College of Medicine, where he also serves as the co-director of the Texas Children’s Center for Vaccine Development (CVD) and Texas Children’s Hospital Endowed Chair of Tropical Pediatrics.

There are approximately 300 reported cases of monkeypox in about a dozen countries. However, Dr. Peter Hotez believes we are well equipped to prevent and treat the viral infection.

“I Have a Lot More Optimism That We’ll Be Able to Contain This Monkeypox Outbreak”

Madeline Belk, PharmD, says that her institution, Huntsville Hospital in Huntsville, Alabama, has restricted prescribing privileges of fidaxomicin to the infectious disease (ID) and gastrointestinal (GI) providers only. And with the 

 now recommending fidaxomicin for first-line therapy, Belk, et al decided to evaluate patients hospitalized with CDI who received treatment with oral vancomycin to determine outcomes and if they needed to shift to prescribing fidaxomicin. 

They performed a retrospective cohort study with adult patients hospitalized for CDI and who received vancomycin. These patients were analyzed between January 2020 and December 2020 and were excluded if they received additional CDI therapies or were receiving treatment prior to hospitalization.

“One-hundred and eighteen patients were included in the analysis. On average, patients were 66 years old, most were female (58%), hospital length of stay was 12 days, most had CDI severity of mild-moderate or severe, and average duration of treatment was 14 days,” the investigators wrote. “Only 3 of 118 (2.5%) experienced recurrent CDI at 60 days. Thirty-day readmissions occurred in 23 (19%) of patients with only 3 (3%) deemed to be related to CDI. Variables associated with increased likelihood of 30-day readmission included age 65 and older (OR 4.53, 95% CI 1.12–18.37; p=0.034) and higher CCI score (OR 1.40, 95% CI 1.04–1.89; p=0.025).”

The investigators concluded that using oral vancomycin as a first-line therapy had low rates of recurrence and CDI-related readmissions, and they decided to keep fidaxomicin with the GI and ID providers.

The study, “Characteristics of patients hospitalized with Clostridioides difficile infection and treated with vancomycin,” was presented at the 

 spoke to study coauthor Belk at the MAD-ID meeting who provided more information about the study’s findings.

With limitations on fidaxomicin at their facility, a hospital looked at vancomycin usage to determine if they needed to align with the new IDSA/SHEA CDI treatment guideline.

Examining Oral Vancomycin as a First-Line CDI Therapy

Although CDI remains the most common healthcare-associated infection, antimicrobial resistance surveillance for 

As such, a team at the University of Houston College of Pharmacy examined hospitalized CDI patient samples from 2 Greater Houston Area health systems to further understand potential vancomycin (VAN) and metronidazole (MTZ) resistance.

“Of 355 isolates analyzed, 18% and 26% were resistant to MTZ and VAN, respectively,” the investigators wrote. “MTZ MICs ranged from 0.25 – 8 mg/L, with a MIC50 of 0.25 mg/L and a MIC90 of 2 mg/L. VAN MICs ranged from 0.5 – 16 mg/L, with a MIC50 of 2 mg/L and a MIC90 of 4 mg/L. RT F027 demonstrated increased resistance to both VAN and MTZ. A subgroup analysis based on location exhibited numerically higher susceptibility rates at community institutions versus hospitals in the TMC.”

 Antibiogram for Vancomycin and Metronidazole Susceptibility,” was presented at the 

 spoke to study coauthor Taryn Eubank, PharmD, BCIDP, Infectious Diseases Research fellow, University of Houston College of Pharmacy at the MAD-ID meeting who provided insights on the study and some of the takeaways looking at susceptibility testing.

A team of investigators studied Clostridioides difficile infection (CDI) isolates to gauge resistance in the 2 antibiotics.

Assessing Vancomycin and Metronidazole Susceptibility for CDI

Urinary tract infections (UTI) continue to be one of the most common bacterial infections. There have been studies demonstrating that the addition of a ambulatory antimicrobial stewardship pharmacist (ASP) can have a positive impact on antibiotic prescribing practices for UTIs.

Novant Health in North Carolina began a pilot program with a UTI care pathway to guide empiric treatment, and utilizing an infectious disease pharmacist to provide education, feedback, and support for select outpatient clinics.

A team of investigators did a retrospective study within 2 Novant outpatient clinics to determine if it was in fact helping with outcomes. “The composite endpoint being appropriate antibiotic selection, dose, and duration of UTI treatment. The secondary endpoints included an analysis of each component of the primary endpoint, incidence of provider-initiated drug information questions, incidence of organism-empiric antibiotic mismatch, and incidence of mismatches that were not prescribed appropriate definitive therapy,” the investigators wrote. “A subgroup analysis of appropriate management at each clinic site was performed.”

There was a total of 211 patients with 126 of them in the pre-ASP group and 85 in the post-ASP group. The majority of the patients were prescribed nitrofurantoin.

The investigators noted, “appropriate UTI management occurred in 66 (61%) of the pre-ASP group compared to 46 (62%) of the post-ASP group (p=0.83). No significant difference was seen in appropriate selection, dose, or duration between the groups (p=0.34; p=0.39; p=0.75). There were 11 provider-initiated questions and 36 organism-empiric antibiotic mismatches (17 in the pre-ASP, 19 in the post-ASP) with only 1 mismatch not prescribed appropriate definitive therapy.”

They also found there was no difference in appropriate UTI management in the clinic A cohort (pre-ASP 83%; post-ASP 83%; p=1). However, the investigators found appropriate UTI management significantly increased in clinic B cohort (pre-ASP 16%; post-ASP 42%; p=0.01).

“Improvement in appropriate UTI management was observed after implementation of a UTI care pathway and an infectious diseases pharmacist pilot at the outpatient clinics,” the investigators wrote.

The study, “Ambulatory Antimicrobial Stewardship Impact on Treatment of Urinary Tract Infections,” was presented at the 

 spoke to study coauthor Melanie Schrack, PharmD, at the MAD-ID meeting who provided insights on the study and how ASPs can help guide treatment.


A health system piloted a program that explored having an infectious disease pharmacist aid in guiding treatment.

The Role of a Stewardship Pharmacist in Treating UTIs in the Outpatient Setting

A successful transitions of care (TOC) antimicrobial stewardship program cuts down on inappropriate antibiotic prescribing by working across stakeholder groups, investing in education for all levels of care, developing a workflow plan, and tracking key metrics.

Nicholas Mercuro, PharmD, an infectious diseases pharmacist at Maine Medical Center, shared these steps to building a successful TOC stewardship program in a talk at the 

Making a Difference in Infectious Disease (MAD-ID) 2022 annual meeting

, held May 18-21, 2022, in Orlando, Florida. He discussed his presentation in a video interview with 

This transcript has been edited for clarity and length.

®: What is the general trend of antibiotic prescribing at hospital discharge currently?

Mercuro: The general trend of prescribing at hospital discharge, especially with things like community acquired pneumonia [and] urinary tract infections, is prolonged durations of therapy and excessive, unnecessary antibiotics. In particular, for things like asymptomatic bacteruia, estimates in the US between 40% to 70% have either an excess duration and/or unnecessary antibiotics. This can be problematic due to things like increasing 

, multidrug-resistant infections and antibiotic-related adverse effects. All those increase with every additional day of antibiotic therapy.

®: In your talk, you discussed the key steps in implementing interventions. Can you summarize those?

Mercuro: The key steps of trying to implement an antimicrobial stewardship program…One is understanding the baseline data and what the benefits are of optimizing an antibiotic regimen at discharge [where] we know [they are given] exceedingly inappropriate[ly]. And then taking a look at your own institution and trying to find, what are your prescribing trends? And are there any specific populations that might benefit the most? So bringing that to the key stakeholders and other people who may be interested in stewardship, getting them on your team, going to all those individual units, getting prescribers, nurses together, informatics to try to build and design this intervention where perhaps you could have a clinical pharmacist intervening at time of discharge.

It's going to be different in all different hospital settings naturally, as you have a variety of resources, maybe different electronic health records, or a different number of stewardship pharmacists or resources or clinicians. And then once you're able to implement that intervention, you want to study it and do quality improvement, spend some metrics on it, the stakeholders are going to be very interested in how successful that intervention may be, and how to further optimize it.

®: What challenges stand in the way of successful stewardship transitions of care programs?

Mercuro: Some of the biggest challenges of implementing a transitions of care program is going to be to get everybody on the same page who's going to be involved in the intervention, as transitions of care can be complex and intricate, and to have everybody kind of on board and able to put resources forward, especially when resources are very limited. You need to kind of take that pitch, bring it to leaders in the health system, in the C-suite, in all the different departments to bring them together. The widespread education takes a lot of time, so you want to start small, think about the areas [where] you're going to benefit the most to kind of be a model for the rest of the departments and the rest of the floors.

®: What is the key takeaway here for ID clinicians?

Mercuro: I think some of the key takeaways is that it's very important to understand your own institution so that you can customize these interventions to the resources that you have. Not all of them are going to be the same. You want to leverage electronic health records and interventions where they can be low-hanging fruit wins but, at the same time, be very targeted in your approach [so] you're going to have high success in the population at hand.

Designing a transitions of care stewardship program and engaging all stakeholders can help cut down on unnecessary antibiotic prescriptions.  

Hospital Discharge a Key Opportunity to Practice Antimicrobial Stewardship

Using an area under the curve (AUC) rather than a trough-dosing strategy for vancomycin in combination with piperacillin-tazobactam could help avoid negative clinical outcomes such as acute kidney injury (AKI), according to a poster presented at the 

, held May 18-21, 2022, in Orlando, Florida.

Sara Alosaimy, PharmD, who completed the research during her time as a research scientist at Wayne State University, discussed her findings in a video interview with 

®: Can you talk a bit about what the motivation behind the study was?

Alosaimy: The motivation was related to the change in the guideline of vancomycin dosing and monitoring where there was a switch recommendation from trough-associated monitoring to AUC [area under the curve]. The aim of the switch was to reduce the incidence of AKI. However, there are combinations, specifically β-lactamwith vancomycin, that are generally more associated with an increased incidence of AKI. So the idea was, could vancomycin dosing strategy have an impact in the drug interaction that we know already of vancomycin and piperacillin-tazobactam.

Alosaimy: What we hypothesized is that vancomycin AUC monitoring will reduce the incidence of AKI in a similar manner to what we've noticed in the guideline, when using vancomycin alone. We did see a reduction in acute kidney injury, however, it was minimal and not statistically significant, regardless of the method of monitoring.

®: What is the key takeaway for clinicians?

Alosaimy: One more thing that I think it would be important to highlight, because it's very related to the key message is, although we were not able to see a statistically significant reduction using the AUC-based monitoring, we did notice that the trough-monitored patients have had more advanced stages of acute kidney injury. When you compared it to the AUC-related patients, their acute kidney injury and the damages were actually more on the initial and primary manageable adverse drug reactions. So that was interesting because, as you know, the more advanced acute kidney injuries you get, then it's related with more permanent side effects, and also more consultations and renal replacement therapy.

To circle back to your question, I think the take home message is to keep collecting the data as AUC monitoring becomes the standard of care in the guideline and see how that impacts any vancomycin-related drug interaction, not just with piperacillin-tazobactam, because it might have an impact into renal disease progression when it occurs because of this drug interaction.

®: Are there any plans for future research?

Alosaimy: We plan on continuing to expand the sample size of the study and then to look specifically into the patient's related factors for acute kidney injury to make sure that there were no confounding variables that may have prevented us from seeing the actual impact of the monitoring method, regardless of the patient group.

®: Taking a step back, what do you think the biggest challenge facing antimicrobial stewardship right now is?

Alosaimy: I think the biggest challenge is that there are a lot of stakeholders when it comes to antimicrobial stewardship and these stakeholders, we need to know what their responsibilities are and how we can both help each other because there are different challenges related to the type of institution and there are different stakeholders regardless of what the institution is. It is very difficult to have one standardized approach for everyone, regardless who that stakeholder is and where you coming from.

Can clinicians rely on dosing strategy to avoid acute kidney injury for patients receiving vancomycin with a β-lactam like piperacillin-tazobactam? 

Vancomycin With a β-Lactam: Comparing Acute Kidney Injury Rates of Trough vs AUC Dosing

(CDI) management in the inpatient setting has been well-documented, so a team of investigators at Carilion Roanoke Memorial Hospital, Roanoke, Virginia, wanted to see how patients in their ambulatory settings were going through the continuum of care.

A total of 50 patients were included from family/internal medicine (FM/IM), urgent care, gastrointestinal(GI), and pediatric sites.

“Management of CDIs was appropriate at only 18% (9/50) of sites, with the highest percentage of appropriate management occurring at UC sites at 38% (3/8). CDI testing was also not consistent throughout the sites, with 30% (15/30) of the CDI testing using a stool culture with reflex to toxin B PCR,” the investigators wrote. “Treatment of negative CCNA results also occurred in 28% (N=14) of patients, with pediatrics being the only site delaying treatment until CCNA returns.”

In addition, they noted that 64% of patients were treated with oral vancomycin, 18% with metronidazole, and 18% fidaxomicin.

“CDI is not appropriately managed at the majority of ambulatory sites at Carilion, and additional education opportunities exist on the management of CDIs with emphasis on updating diagnostic testing to only allow toxin B PCR with reflex CCNA and utilizing fidaxomicin first-line in treatment,” the study investigators concluded.

The study, “Management of Clostridioides difficile Infections at Ambulatory Practices,”was presentedat the 

24th Annual Making a Difference in Infectious Disease (MAD-ID) Meeting 2022,

 spoke to study coauthor Yang Zhao, PharmD, BCPS at the meeting who provided insights on the study, and the adoption of fidaxomicin in the clinical setting.




Investigators sought information on how the infection is treated in outpatient clinics

Managing CDI in the Ambulatory Setting

How to manage infections caused by extended spectrum beta-lactamase (ESBL)-producing bacteria, what pathogens to be on alert for, and how to approach oral carbapenems were all hot topics in 2 presentations at the 

, held May 18-21, 2022, in Orlando, Florida, by Jason Pogue, PharmD, BCPS, BCIDP, clinical professor of pharmacy at University of Michigan College of Pharmacy.

® for a video interview to discuss his talks and share key takeaways for infectious diseases clinicians.

®: Can you summarize the key points from your presentation, "Treatment of Challenging Gram Negative Infections"?

Pogue: For the first session at MAD-ID, we'll be focusing on 3 particular problematic gram negatives. The first one we're going to talk about is managing ESBL infections. There's a clinical controversy surrounding whether or not you can use piperacillin-tazobactam or if you have to start with the carbapenems, or if that's the preferred therapy in that situation, and so we'll be [taking] a deep dive into the literature support. And hopefully, by the end of the talk, I'll convince you that if you have a patient with an invasive ESBL infection, they should get a carbapenem.

The second thing that we're going to talk about is focusing on AMPc-producing organisms. We're going to try to myth bust a little bit in that presentation. Hopefully, by the end of that, the SPACE acronym [

Serratia, Pseudomonas, Acinetobacter, Citrobacter, Enterobacter

] will be out of your mind. And you'll be thinking HECK YES [

Hafnia alvei, Enterobacter cloacae, Citrobacter freundii, Klebsiella aerogenes, Yersinia enterocolitica

], and Sam Aitken will be in your mind instead.

Then the last part we're going to touch on is really the most problematic organism, which is carbapenem-resistant 

, a challenging pathogen, very difficult to treat with our current options. We're going to focus on probably the 2 most popular current options and deep dive into the data for ampicillin/sulbactam and for the tetracyclines. I'm going to get to leave [you on] a positive note though, because there is a new agent coming in the 

 space, sulbactam-durlobactam. I'm going to present a little bit of the data that was presented at 

®: What is the main takeaway for infectious diseases clinicians?

Pogue: Bottom line, takeaway No. 1 is to use carbapenems over piperacillin-tazobactam for ESBL. Please, I beg of thee.

Second, when you're thinking about AMPc situations where you should really want to avoid a drug like ceftriaxone, the organisms you should really be focused on there are 

Enterobacter cloacae, Klebsiella aerogenes

, you're probably okay to use drugs like ceftriaxone. And then for 

, good luck, in a lot of ways. But really, what's really important to note is that for amp-sulbactam, we’ve got to be pretty aggressive in our dosing. We're going to want to be giving extended infusions as the standard of care. But then, in addition to that, with regards to tetracyclines, know that there's more that goes into it than just the S for susceptible. A lot of those breakpoints are actually too high, and you probably have to pay a little bit closer attention before you choose which tetracycline to use.

®: Can you describe the basis for your second talk, "Oral Carbapenems Are Coming: Are You Excited or Anxious?"

Pogue: The oral coverage, that's going to be a fun one. That's a fun talk. So one of my former residents and I, Katie Barber, will be debating, are we excited or anxious about oral carbapenems? I will be taking the anxious side, and not just because I'm an anxious guy, which I am, [but] that's just a coincidence in this situation. It's a little bit of a funny—funny is a bad word choice—it's a little bit of an interesting topic to be had now, since a week or 2 ago, the oral carbapenem that we were really focused on discussing was kind of rejected by the FDA or 

they had to go back and do additional stuff

. So the “they are coming part” is a little bit less soon that we're going to see that. But I'll be focusing on the con and I will be honest, I do have anxieties about [oral carbapenems]. There's a reason we don't currently have one, and that main reason is that the compounds have very poor oral bioavailability and so your exposures are very borderline. When you start to go through the [pharmacokinetics/pharmacodynamics], you look at the clinical data, there are a lot of warning signs that come out. I'm hopeful, I'd love to have oral carbapenems for my patients, but there's a reason to be anxious, there're definitely some issues there and some red flags.

®: And the bottom-line takeaway for clinicians there?

Pogue: The main takeaway that I would have is that, unfortunately, it's not going to be an issue in the near future, because it's going to be a while again before we see an oral carbapenem. But what's really key is…let's just use, for example, had tebipenem made it, because it would have been available probably within the next month or so or it would have been available in the very near future. It's really important that, even for an oral antibiotic, we do all the appropriate preclinical work to make sure that the dose is right that we can achieve our PK/PD targets and that the clinical data support that, because like I said, if you look at those data, there's a lot of things that pop out at you.

Jason Pogue, PharmD, BCPS, BCIDP, shares key takeaways from his 2 presentations at MAD-ID 2022, including a new alternative to the SPACE acronym, as well as how to navigate any anxieties around oral carbapenems.

Challenging Gram Negative Pathogens and Oral Carbapenems: MAD-ID Updates With Jason Pogue, PharmD

Adult primary care clinics are a prime target for antimicrobial stewardship efforts, as the levels of inappropriate prescribing are often quite high in this setting.

Tina Zheng, PharmD, a PGY1 pharmacy resident at Maimonides Medical Center in Brooklyn, New York, and colleagues sought to better understand the current antibiotic prescribing patterns at adult primary care clinics affiliated with Maimonides Medical Center. Their results were presented in a poster at the 

Zheng shared the key takeaways of the poster in a video interview with 

Zheng: Recently, there's been a huge movement towards outpatient antimicrobial stewardship. We've made a lot of progress in terms of inpatient antimicrobial stewardship. At our current institution, we've had an inpatient antimicrobial stewardship, otherwise known as AMS, program since 2007. The objective of this project was really to see how are we doing in the outpatient setting with our primary care clinics. I think there have been a lot of articles that have been coming out in 

 recently regarding how are we doing the outpatient setting? What can we do? What sort of interventions can we implement in order to improve the rates of antibiotic prescribing in these settings?

®: Why do you think the rates of inappropriate prescribing are so high in the adult primary care setting?

Zheng: I think in terms of primary care settings, a lot of us know that primary care providers have a lot on their plates. There's also a lot of patient preference in terms of coming to the clinics if they have some sort of stuffy nose and wanting an antibiotic because that's what they had when they were kids or whatever worked previously. I think it's that patient demand as well. But additionally, with the newer literature coming out that shorter is better, so shorter durations [as well]. Not all primary care providers have the time to really look into that and summarize all that data. I think by providing resources to our outpatient providers, primary care providers, we can really help them to make the best choices in terms of antibiotic therapy.

Zheng: This was interesting. This was sort of an initial project where we wanted to first see what our baseline was [and] how are we doing in the clinics and then seeing what problem areas that we have that we could probably improve upon. From our results, we found that our total rate of inappropriate antibiotic prescribing was around 61%. I know the CDC reports that around 50% of antibiotics are [used] inappropriately. We also found that 22% of our antibiotics were unnecessary. Otherwise, meaning that they weren't indicated for that diagnosis at all. We sort of reflect the CDC rate of 28% of all antibiotic prescribing [being] unnecessary.

Then we further broke it down. So from that total, inappropriate antibiotic prescriptions were identified as inappropriate if they were for the wrong indication, if they were for the wrong antibiotic, [or] wrong dose, wrong duration. And so that's what the 61% is.

Then we looked into each category. For the rates of inappropriate antibiotics and inappropriate doses, we found that that was pretty similar at 31%. But we did notice that our biggest problem area was duration of therapy. So that was around 54%, I believe. So very drastic compared to the other ones, obviously, the other ones we can also make more improvements upon. But seeing this duration of therapy, we knew that that's where we had to target our provider education, or at least provide some sort of guidance for them to really make it easier for them in terms of selecting the appropriate antibiotic regimen.

Zheng: The key takeaway currently [is that] I think it kind of reinforces that we have a lot of work to do in the outpatient setting. I think it is interesting. In addition to our primary end points, in terms of the characterization of all these antibiotics, we found that a majority of these antibiotics were for urinary tract infections, which was very interesting. I think we were really expecting more respiratory infections, since the literature really shows the pneumonias or the sinusitis, bronchitis, but we saw a lot of urinary tract infections. So based off of those more common indications, we really strive to create more education around those specific infections. 

I think the key takeaway really is that you can definitely help out providers with giving them more specific guidance for appropriate antibiotic dose and duration as well as helping them to differentiate when antibiotics are needed for specific indications such as bronchitis, or pharyngitis, where antibiotics really aren't recommended. I think this just sets the stage for interventions to come in order to improve antibiotic prescribing patterns there.

Zheng: In terms of future directions with this project, we actually have implemented clinical guidelines to help these providers, as well as give education to the provider. We have actually gone in to meet with the primary care providers to give them education on this and I think what we've been seeing is, in terms of having a bigger success with sort of building that rapport with primary care providers, is to really meet them face-to-face and meet them from where they're coming from and not to take things off on negative spin because obviously, they're doing the best that they can and we're just there to help them in terms of infectious diseases providers. We should work together as a team in order to improve on this effort.

A MAD-ID 2022 poster sought to better understand the current antibiotic prescribing patterns at adult primary care clinics affiliated with Maimonides Medical Center in New York.

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