Infectious Diseases, Nurse Practitioners, and Appropriate Antibiotic Prescribing

Guest Editorial

Infectious Diseases, Nurse Practitioners, and Appropriate Antibiotic Prescribing Ann Marie Hart

A

ntimicrobial resistance (AMR) is a growing problem that

4. In addition to microbial coverage, consider patient age,

threatens the health of our patients, our loved ones, and

allergies, comorbidities, recent antibiotic use, pregnancy

ourselves. Simply put, AMR is the biological response

(or the potential for pregnancy), lactation status, renal and

of microorganisms to the selective pressure of antibiotics.

hepatic functions, drug cost, drug-related adverse effects

The more we use antibiotics, the more microorganisms will

and toxicities, and the patient’s ability to conform to the

respond by developing resistance mechanisms. Unfortunately,

prescribed antibiotic regimen. Also consider individual

AMR has the potential to affect and harm everyone—even

community antimicrobial resistance patterns; summaries

persons who have never actually received antibiotics.1 It is unlikely that we will ever be able to completely stop

of which are available from hospital laboratories. 5. After identifying the best antibiotic choice for the actual

microorganisms from developing antibiotic resistance mech-

or suspected pathogen, prescribe the antibiotic only for

anisms; however, we can decrease the rate of AMR by pre-

the recommended treatment length (not longer), and

scribing antibiotics appropriately. Appropriate antibiotic

advise the patient to take the full course (ie, not to hoard

prescribing requires knowledge of microbiology, pathology,

or share them). Similarly, advise patients on what to do

and pharmacology, as well as familiarity with current research-

if they experience adverse reactions to antibiotics.

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based prescribing recommendations. However, most nurse

6. To help with the aforementioned principles, consult with

practitioners (NPs) receive minimal education about AMR and

an infectious diseases expert or use a current antimicro-

appropriate antibiotic prescribing,3 and many prescribe anti-

bial reference guide such as the Sanford Guide to

biotics inappopriately. This issue is dedicated to helping NPs

Antimicrobial Therapy (www.sanfordguide.com), which

diagnose and manage several of the most common infectious

is updated annually.

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diseases seen in primary care: acute respiratory infections, pneumonia, HIV, urinary tract infections, and sexually transmitted diseases. In addition, avian influenza and human immunodeficiency virus (HIV) disease are discussed to help NPs stay abreast of other emerging and important infectious diseases. Finally, as no one article or journal issue can adequately prepare NPs for all the infectious diseases experienced in clinical practice, here are some basic principles for prescribing antibiotics appropriately.5,6 1. Know which infections warrant antibiotic therapy. For example, antibiotics do not alter the course or duration of acute uncomplicated bronchitis; however, they do reduce the length and severity of streptococcal pharyngitis.

References 1. Knobler SL, Burroughs R, Mahmoud A, et al, eds. The Resistance Phenomenon in Microbes and Infectious Disease Vectors: Implications for Human Health and Strategies for ContainmentWorkshop Summary (Institute of Medicine). Washington, DC: National Academies Press; 2003. 2. Niederman MS. Principles of appropriate antibiotic use. Int J Antimicrob Agents. 2005;26(suppl 3):S170-S175. 3. Sym D, Brennan CW, Hart AM, et al. Characteristics of nurse practitioner curricula in the United States related to antimicrobial prescribing and resistance. J Am Acad Nurse Pract. In press. 4. Ladd E. The use of antibiotics for viral upper respiratory tract infections: an analysis of nurse practitioner and physician prescribing practices in ambulatory care, 1997-2001. J Am Acad Nurse Pract. 2005;17:416-424. 5. Green M. Appropriate principles in the use of antibiotics in children. Clin Pediatr. 1997;36:207-208. 6. Gilbert DN, Moellering RC, Eliopoulos GM, et al. The Sanford Guide to Antimicrobial Therapy 2007. 37th ed. Sperryville, VA. Antimicrobial Therapy, Inc; 2007.

2. Whenever possible, identify the specific cause of the infection (ie, obtain a culture). For situations in which cultures are either unavailable or inappropriate (eg, bacterial sinusitis, otitis media) and treatment is empirical,

This issue‘s guest editor, Ann Marie Hart, PhD, FNP, is an assistant professor at the University of Wyoming in Laramie. She can be reached at [email protected].

determine the most likely causative pathogen(s) associated with the particular infection. 3. After identifying the actual or most likely pathogen, choose

1555-4155/07/$ see front matter © 2007 American College of Nurse Practitioners doi:10.1016/j.nurpra.2007.07.022

a narrow-spectrum antibiotic that will cover the actual or suspected microorganism(s).

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The Journal for Nurse Practitioners - JNP

October 2007