Antibiotic Awareness Week 2023

Leveraging State & Federal Health Departments to Promote Health Equity 

This year for US Antibiotic Awareness Week, the emphasis is on improving antibiotic use and health equity. This fall I had the opportunity to attend the SHEA workshop on Advancing Health Equity in Antimicrobial Stewardship where practitioners gathered to learn and discuss current inequities and strategies to improve equity in antibiotic prescribing. A highlight was the discussion on the recently published Open Forum Infectious Diseases review article on health equity and antibiotic prescribing in the US (Kim, et al.). Among many other factors of inequity, this systemic review highlighted disparities in prescribing trends based on geography. Here in the South, we have the highest rate of antibiotic use in the United States (CDC Antibiotic Resistance & Patient Safety Portal) and subsequently higher rates of inappropriate prescribing for respiratory infections compared to other areas in the country (Hersh, et al.). Patients living in rural areas are more likely to receive (inappropriate) antibiotics than those in urban areas (Wattles, et al.). Many of the areas with increased antibiotic prescribing have more limited resources than urban medical centers.

Antimicrobial stewardship programs within state and local health departments have platforms to advocate for equitable access to high quality healthcare in all practice settings. At the Tennessee Department of Health (TDH), guided by the CDC’s Core Elements of Antibiotic Stewardship for Health Departments, we provide technical assistance, form stewardship collaboratives and support the development of stewardship guidance in healthcare settings throughout our state. We focus our efforts on settings with limited access to stewardship expertise such as critical access hospitals, outpatient settings and long-term care facilities. We have established a grant to provide financial and technical support to small and critical access hospitals to submit data into NHSN’s Antibiotic Use Option. To promote appropriate antibiotic prescribing in the outpatient setting, TDH collaborates with Vanderbilt University to provide stewardship expertise and prescribing feedback to outpatient family medicine practices and urgent care clinics. Additionally, we also work in the long-term care sector to educate on appropriate antibiotic prescribing for pneumonia.

Antimicrobial stewards in all healthcare settings can work together to provide equitable access to stewardship expertise in resource limited areas and effectively promote optimal antimicrobial use.

Callyn Wren, PharmD

Callyn Wren, PharmD, BCIDP – Pharmacist, Healthcare-Associated Infections and Antimicrobial Resistance Program, Tennessee Department of Health