American College of Physicians: Internal Medicine — Doctors for Adults ®


College launches new clinical theme to help combat antibiotic resistance

From the April 2000 ACP-ASIM Observer, copyright 2000 by the American College of Physicians-American Society of Internal Medicine.

By Deborah Gesensway

The College's full-court press to combat the inappropriate use of antibiotics and immunizations will begin at this year's Annual Session in Philadelphia.

For the next two years, ACP-ASIM will devote resources to everythingfrom giving internists tips on how to dissuade patients who demand unnecessary antibiotics to educating the general public about the latest thinking on how to treat sinusitis without antibiotics. The College will also work with the Centers for Disease Control and Prevention and other specialty organizations, including the Infectious Disease Society of America, to improve the use of antibiotics.

"Emerging antibiotic resistance: appropriate use of antibiotics and immunization" is the College's first clinical theme. The Board of Regents selected the topic after former President Harold C. Sox, MACP, proposed that the College select one topic every year or so in an effort to dramatically improve internal medicine practice.

"If the inappropriate use of antibiotics is 50%—and I suspect it's worse than that—and we can lower it to 35%, that amounts to thousands and thousands of people and lots of dollars," explained Herbert Waxman, FACP, the College's Senior Vice President for Education. "We think we can make a difference if we focus a substantial proportion of our educational efforts on an area where there is a big gap between ideal and actual practice."

"The idea is to better muster the resources and talents of the College, its members and other medical organizations to get behind a theme so that we can have a measurable impact on the nation's practice and knowledge in this area," said Scott C. Litin, FACP, former ACP-ASIM Governor for Minnesota and a member of the College's clinical theme project workgroup.

As a general internist, Dr. Litin said that he does not want the College to use its clinical theme programs to scold physicians for overprescribing antibiotics in marginal cases. Instead, he wants to give physicians real tools to help them teach their patients how unnecessary antibiotics can create problems for them and their families, as well as for society as a whole.

"When it's you and your kid, you don't really care about society as a whole," Dr. Litin said about patients in the exam room. "But if you understood that your kid could develop a rash or get diarrhea, that it's not going to help anyway and they might have an adverse drug reaction, then you might listen to the doctor's advice."

Annual Session courses devoted to the clinical theme will explore antibiotic resistance in tuberculosis and sexually transmitted diseases, and how antibiotic resistance relates to food-borne infections. There will also be panels on new thinking on the immunization of adults and how to prevent bacterial resistance in the intensive care unit. One of the popular "Multiple Small Feedings of the Mind" sessions will address how to work up and manage antibiotic-resistant conditions.

In addition, this fall's "Doctors for Adults" campaign will draw from the College's new sinusitis clinical practice guideline, which was approved last fall by the Board of Regents. The guideline, which has been submitted for publication, states that existing scientific evidence suggests that physicians can do much more "watchful waiting" of bacterial sinusitis than they tend to do. "If the symptoms are mild to moderate, you can actually do watchful waiting for up to 10 days, and it usually goes away on its own," without any antibiotics at all, explained Vincenza Snow, ACP-ASIM Associate, the College's Senior Medical Associate and a co-author of the sinusitis guideline.

Dr. Snow said the College is preparing a patient version of the clinical practice guideline. The idea is to supply physicians with material they can hand to patients who demand unnecessary antibiotics.

Other practice guidelines in the works on topics related to the College's clinical theme include management of acute exacerbations of COPD and of dyspepsia.

Annual Session and antibiotic resistance

The following Annual Session courses relate to the College's clinical theme of emerging antibiotic resistance:

What: "Preventing Transmission of Resistant Agents in the Hospital"
When: Thursday, 7:45-8:30 a.m.
Where: Room 112

What: "Multiple Small Feedings of the Mind, Part 1—Emerging Antibiotic Resistance"
When: Thursday, 1:30-3 p.m.
Where: Ballroom A

What: "Antibiotic Resistance in Sexually Transmitted Diseases"
When: Thursday, 3:45-5:15 p.m.; Friday, 8:45-10:15 a.m.
Where: Room 113 B/C; Room 103 B

What: "Twelve Steps to Controlling Antimicrobial Resistance in Hospital Patients"
When: Friday, 11 a.m.-12:30 p.m.; Saturday, 1:30-3 p.m. Where: Room 201 A

What: "Antibiotic Resistance in Tuberculosis: Clinical Impact"
When: Saturday, 8:45-10:15 a.m.; Sunday, 7-8:30 a.m.
Where: Room 201 A

What: "Bacterial Resistance: Case Studies"
When: Saturday, 11 a.m.-12:30 p.m.
Where: Room 201 A

What: "Antimicrobial Resistance, Food-Borne Infections"
When: Saturday, 3:45-4:30 p.m.
Where: Room 204 A/B

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