Antibiotic medications are among the greatest advances in the history of medicine, saving millions of lives by treating bacterial infections that once were often fatal. However, inappropriate prescription of antibiotics has contributed to the rise of drug-resistant bacteria that are increasingly difficult to treat, and can expose patients to side effects and other problems.
It’s estimated that 30% of outpatient antibiotic prescriptions in the United States are inappropriate. Often, that means they’re prescribed for conditions caused by viruses, which don’t respond to antibiotics, or the wrong type of antibiotic is used. This is particularly true at urgent care centers, the walk-in clinics typically used for non-life-threatening illnesses and injuries needing prompt attention.
Most of the attention in addressing this problem has been focused on reining in prescription of antibiotics when they’re not needed. Timothy Jenkins, MD, of the University of Colorado Anschutz School of Medicine, says another facet of the problem gets less attention: When antibiotics are appropriate, doctors often prescribe them for too long.
“Just as overprescribing antibiotics increases exposure to antibiotic therapy unnecessarily, so does prescribing a longer duration of therapy than is needed to cure an infection,” says Jenkins, an associate professor in the CU Anschutz Division of Infectious Diseases.
So, Jenkins, who practices in the infectious-disease department at Denver Health, and his colleagues introduced a program to encourage providers at urgent care centers to limit antibiotic prescriptions to five days or less. It’s called “Take 5.”
The research team recently published a study of how well the Take 5 program is working – and reported encouraging results. The article – “The Take 5 Campaign: Effects of an Intervention to Promote Five-Day Durations of Antibiotic Therapy for Common Infections in Urgent Care,” of which Jenkins is the corresponding author – was published in the journal Open Forum Infectious Diseases.
Jenkins and his colleagues believe theirs is the first publication describing a multifaceted intervention to shorten prescribed durations of antibiotic therapy for a broad range of infections encountered in urgent care.
Promoting shorter duration
For patients who come into urgent care centers with common bacterial infections of the skin, urinary tract, sinus, and ear, as well as pneumonia and flareups of chronic obstructive pulmonary disease (COPD), a five-day course of antibiotics is usually enough. But Jenkins says studies show that prescriptions as long as 10 days are the norm at urgent care centers, especially for conditions such as acute sinusitis and acute otitis media (a middle-ear infection).
“Any antibiotics are potentially associated with side effects, drug interactions, and the development of resistance. The longer that the antibiotic course is, the longer we’re putting patients at risk of these unintended consequences,” Jenkins says. “So, promoting use of the shortest effective duration of therapy is an approach we can take to reduce unnecessary antibiotic exposure for our patients.”
Denver Health, a clinical partner of the CU Anschutz School of Medicine, provides urgent care services at its central Denver main hospital campus and at satellite locations.
Efforts were already underway at Denver Health to improve stewardship of how antibiotics are prescribed at these centers. Standardized guidance for treatment of common outpatient infections has been available via a smartphone application for common outpatient infections since 2014, and previous research led by Jenkins showed the app is widely used by clinicians.
The app recommended no more than five days of antibiotic therapy for many common infections. Still, a research study by a former infectious-disease pharmacy resident showed that many antibiotics prescriptions for common infections at Denver Health urgent care sites were for seven or 10 days.
A Take 5 campaign informational graphic promoting five-day durations of antibiotic therapy for common infections, posted at urgent care centers. Courtesy Timothy Jenkins, MD.
Active intervention
Jenkins and his colleagues thought an active intervention could produce better results. In late 2019, the Take 5 campaign was introduced at the main Denver Health urgent care center and at a Denver Health community health center.
Take 5 used multiple approaches to get the message across, including educational sessions and emails for urgent care clinicians about limiting prescription durations, informational graphics posted in work areas, monthly individual feedback showing each clinician how their prescribing practices compared to those of peers, and updates to electronic prescription forms to make the five-day option easier to select.
Also, “peer champions” at each clinic – well-respected physicians or advanced practice providers – were enlisted to advocate for the campaign.
In the new study, Jenkins and his collaborators reviewed anonymous data on more than 32,000 urgent-care visits from 2017 to 2023 at the two sites participating in Take 5, comparing antibiotics prescribing patterns for several common bacterial infections before and after the campaign launched in late 2019. They also looked for any changes to medical outcomes for those patients.
The results were striking:
- The percentage of antibiotics prescriptions for more than five days had been gradually decreasing even before the Take 5 campaign began. But still, the rate of five-day-or-less prescriptions was only 57.5%.
- After the start of Take 5, the rate improved dramatically, with an immediate jump of about 10 percentage points, and eventually reached 82.9% for prescriptions of five days or less.
- There was a 21% reduction in antibiotic prescription days after Take 5 launched.
Chart shows the percentage of antibiotic prescriptions for five days or fewer at two urgent care sites before and after the launch of the Take 5 intervention (red line). Courtesy Timothy Jenkins, MD.
‘A big difference’
“The rapid improvement we saw is pretty notable, and not something you often see in interventions when you’re trying to change providers’ prescribing practices,” Jenkins says. “It was pretty clear this made a big difference.”
The research also showed that reducing antibiotic duration didn’t create medical problems. Patients on shorter courses of antibiotics had similar rates of needing additional antibiotics or being hospitalized within two weeks as those on longer courses.
At this point, Jenkins says, the lessons of Take 5 “seem to have been pretty well ingrained in providers, so the impact looks sustainable.”
Other health care organizations have been replicating the Take 5 concept, Jenkins says, and there was considerable interest in the campaign at IDWeek, the Infectious Diseases Society of America’s national conference in October. “That’s what it’s there for, and we’re happy to see others take up this work as well to decrease antibiotic exposure,” he says.
Other CU Anschutz School of Medicine faculty and Denver Health providers who co-authored the study are Lindsey Fish, MD (general internal medicine); Michael Breyer, MD (emergency medicine); Amy Quinones, APRN (family medicine); Cory Hussain, MD (infectious diseases); and Allison Sabel-Soteres, MD, PhD, MPH/MSPH (biomedical informatics).
