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Antimicrobial Stewardship

Working to keep communities safe and healthy.

antibiotics

Our commitment

Intermountain Health has demonstrated a long-standing commitment to taking action against antimicrobial resistance through comprehensive antimicrobial stewardship programs and innovative research initiatives. Our efforts include developing robust infectious diseases and antimicrobial stewardship support for all facilities including small and critical access hospitals, reducing antibiotic overuse in urgent care and outpatient settings, and implementing robust stewardship resources to optimize antibiotic use. Most recently in partnership with Patient Centered Outcomes Research Institute (PCORI), we have launched a patient-centered initiative that will hopefully optimize care for every child we see in the outpatient space at Intermountain. We commit to providing you the best care possible, including using antibiotics only when they benefit you. 

For patients & families

Learn about why it's important to avoid antibiotic overuse.

Every year, you and your family might face a fair share of colds, flus, and sinus infections. Unfortunately, these types of illnesses can have you feeling extremely bad and unlike yourself. In fact, sometimes so unlike yourself that you might try any remedy, treatment, or medication in order to start feeling better. Antibiotics, or “Z-Paks,” are often the patient-desired solution despite what may be best for you. 

In some cases, antibiotics will improve your symptoms, but in many cases they aren’t necessary. Antibiotics don’t work on viruses like the cold or flu, and rarely help with sinus infections.

Antibiotics may actually: 

  • Do more harm than good, with side effects such as nausea, diarrhea, rash, and yeast infections. 
  • Cause a severe form of diarrhea called Clostridioides difficile (C. diff), which can be life-threatening. 
  • Become less effective when used inappropriately. 

To better understand why your doctor could be doing you a favor by not reaching for the prescription pad, let’s break down how antibiotics work: 

To understand how antibiotics work, it helps to know about the two major types of germs that can make people sick: bacteria and viruses. Although certain bacteria and viruses cause diseases with similar symptoms, the ways these two organisms multiply and spread illness are different:

  • Bacteria are living organisms existing as single cells. Bacteria are everywhere and most don't cause any harm, and in some cases may be beneficial. Lactobacillus, for example, lives in the intestine and helps digest food. But some bacteria are harmful and can cause illness by invading the human body, multiplying, and interfering with normal bodily processes. Antibiotics are effective against bacteria because they work to kill these living organisms by stopping their growth and reproduction.
  • Viruses, on the other hand, are not alive and cannot exist on their own - they are particles containing genetic material wrapped in a protein coat. Viruses grow and reproduce only after they've invaded other living cells. The body's immune system can fight off some viruses before they cause illness, but others (colds, for example) must simply run their course. Antibiotics do not work against viruses.

We aim to slow the development of resistance, minimize unintended consequences of antimicrobial use, and improve patient outcomes.

For physicians

We are committed to improving appropriate antimicrobial use throughout the areas we serve.

Antimicrobial stewardship at Intermountain is committed to improving appropriate antimicrobial use system-wide, through coordinated interventions based on the Core Elements of Antibiotic Stewardship. Stewardship optimizes clinical outcomes while minimizing unintended consequences related to the use of antimicrobials, such as adverse medication reactions and antibiotic resistance. Intermountain offers providers resources to deliver the right antimicrobials, when patients need them. 

Infectious diseases experts at Intermountain and the University of Utah are committed to reviewing and updating the below antimicrobial stewardship Care Process Models to guide appropriate antibiotic use. 

Community Acquired Pneumonia (CAP)

Either amoxicillin or doxycycline are the recommended first line antibiotic choices for uncomplicated community-acquired pneumonia in adults. Patients with significant comorbidities or recent antibiotic use should receive doxycycline or azithromycin in combination with amoxicillin-clavulanate, with ceftriaxone administered if available.

Otitis media

Antibiotics are commonly overprescribed for acute otitis media. AOM should be diagnosed based on moderate to severe bulging of the tympanic membrane (TM). Children without a bulging TM are unlikely to have a bacterial infection. Consider delayed prescriptions for most children with AOM. Children <6 months, who are immunocompromised, or who have recurrent AOM should be prescribed an immediate antibiotic. Children least likely to benefit from an antibiotic includes age ≥ 2 years old, temperature <39°C, mild to moderate pain improved with analgesia, unilateral infection, symptoms for less than 72 hours at presentation, and absence of otorrhea.

Sinusitis

Antibiotics are overprescribed for sinusitis. Watchful waiting, with or without a delayed prescription is a recommended treatment option for acute, persistent bacterial sinusitis with symptomatic management. If prescribing, amoxicillin is the recommended first line antibiotic choice.

Skin and Soft Tissue Infections (SSTI)

Purulent cellulitis, e.g. abscesses, are often caused by Staphylococcus aureus, including MRSA and doxycycline or trimethoprim/sulfamethoxazole are first line. Non-purulent cellulitis is typically caused by streptococci such as Group A Streptococcus, cephalexin is first-line.

Strep pharyngitis

Do not prescribe antibiotics for strep without a positive strep test. If signs or symptoms strongly suggest a viral etiology do not test or treat for Group A streptococcus.

Urinary Tract Infection (UTI)

UTIs are overdiagnosed and overtreated. Treating asymptomatic bacteriuria with antibiotics offers no benefits and may cause harm. Assessing patient symptoms, in particular, urinary tract-specific symptoms (dysuria, urgency, frequency, suprapubic pain or pressure and flank pain) is important. With rising antibiotic resistance, nitrofurantoin and cephalexin are preferred empiric therapies. Urine culture follow up is important for complicated or recurrent infection.  

We have developed a watchful waiting and delayed antibiotic prescriptions fact sheet, through which patients will learn how to identify whether and when antibiotics are truly appropriate for their condition. 

Plus, providers can benefit from a new symptomatic therapies checklist, which is used to recommend treatments to relieve symptoms that bring discomfort to patients, without exposing them excessive treatment with antimicrobial agents. 

Prescribing data is available for all urgent care and primary care clinic providers in the Intermountain system through our dashboard. Data is updated every month and can be reviewed for the previous month and as a rolling average at a glance

Antibiograms track local antimicrobial resistance profiles to help clinicians treat patients with appropriate empiric antibiotics until specific susceptibility results become available. Definitive antibiotic therapy should be based on the susceptibility profile of the identified organism(s) and the infection site. Antibiogram information for emergency department and hospitalized patients is compiled annually at Intermountain Health and presented regionally. Please see below links for available community antibiograms. 

Utah

Colorado

Idaho

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