Optimizing Antimicrobial Therapy with Timeouts (CME)
Internet Enduring Material Jointly Provided by:
Stanford University School of Medicine (CME) and Tufts University School of Medicine (CPE)
The Division of Infectious Diseases and Geographic Medicine at Stanford University School of Medicine
Antibiotic misuse is widespread and has dire patient and public health consequences. National organizations, including the CDC and the Joint Commission, advocate for a formal "Antibiotic Timeout" to reassess empiric antibiotics 48-72 hours after their initiation. During this Timeout, clinicians should answer the following questions:
- Does the patient have an infection that will respond to antibiotics?
- If so, is the patient on the right antibiotic(s) and is it being administered in the correct dose and by the correct route and (in the case of intravenous therapy) duration of infusion?
- Can a more targeted antibiotic regimen be used to treat the infection (i.e., de-escalation)?
- For how long should the antibiotic(s) be administered?
This CME/CPE activity provides a practical approach to performing "Antibiotic Timeouts" in the inpatient setting. Using short, didactic sessions, we will provide examples on how to reassess antibiotic therapy started empirically using clinical, laboratory, and microbiological data. The majority of this CME/CPE will be high-yield, interactive inpatient cases covering skin and soft tissue infections, pneumonia, catheter-associated urinary tract infections, and neutropenic fever, that illustrate the timeout process and the principles of appropriate use of antimicrobials.
Who Should Enroll
This course is designed to meet the educational needs of physicians from a wide variety of specialties including cardiology, critical care, family practice, general surgery, hospitalists, infectious diseases, internal medicine, neurology, oncology, pediatrics, and urology, as well as pharmacists, nurse practitioners, and physician assistants.
At the conclusion of this activity, participants should be able to:
- Describe the principles and shortcomings of empiric antibiotic therapy.
- Routinely conduct all steps of the antibiotic timeout, in accordance with CDC guidelines on antibiotic stewardship that include:
- Analyzing laboratory and clinical data
- Formulating a rationale for continued antibiotic use
- Documenting rationale in patient's electronic medical record
- Determining the most effective duration of antibiotic therapy
- Deciding when it is appropriate to switch from an IV to oral route of antibiotic administration