How Do We Transition Patients on Heavy Antibiotics to Outpatient?

Skin and soft tissue infections (SSTIs) are an ongoing challenge that, like many antimicrobial stewardship efforts, were exacerbated by the COVID-19 pandemic.

Bruce M. Jones, PharmD, FIDSA, BCPS, is an infectious diseases clinical pharmacy specialist at St. Joseph's/Candler Health System in Savannah, GA, and a self-proclaimed antimicrobial steward.

“When we talk about some of these newer novel agents, it’s how do we use them but use them for appropriateness, use them for the right patients, so that we maintain that stewardship type of mindset.”

Jones works primarily in the inpatient setting, and spoke frankly about the common problem of patients initially receiving unnecessary antibiotics. “A lot of what we see from a challenge standpoint is these patients come in, they’re on IV antibiotics, it’s usually the main reason why they’re there,” he explained. “How do we transition them to the outpatient side?”

In this mini podcast, Jones breaks down the “very straightforward criteria” he uses to decide whether an SSTI patient should be inpatient or outpatient.

However, there is some nuance. “I always say, sometimes it’s things beyond the infection that will buy that ticket to admission,” Jones noted. “What we’ve found from our research is the number 1 reason why patients get admitted for these infections is failure of outpatient oral therapy.”

Jones emphasized the importance of including patients in the decision of whether they should be inpatient or outpatient. He strives to work with a patient, including them in their own treatment. Jones said, “We find that about 23-26% of the time, just by speaking to them, we can remove that allergy.”

Overall, Jones spoke positively about recent developments in antibiotics and efforts to use them vigilantly. “I feel optimistic about the agents that are out there and where we are with the science. The biggest barrier, I would say, is how do we get that information to the general clinician?”

Tune in to learn more about Jones’s methods and successes with antimicrobial stewardship, as well as a thorough explanation of the daily and overarching challenges he faces as a clinical pharmacist treating SSTI patients.