Stephen Ford, BS, PharmD, BCGP, is a Clinical Pharmacist with Diamond Pharmacy in Indiana, PA. This post is based on his session “Bug and Drug: Principles of Antibiotic Use” taking place at the 2017 Spring Conference on Correctional Health Care in Atlanta, April 29-May 2. Learn more about the conference and register HERE.

Antibiotic overuse and misuse are of concern in all clinical settings; correctional practice is no exception. While our patients are ‘incarcerated’, their treatment is more similar to that of outpatient or ambulatory care rather than inpatient or acute care.

The most common infectious processes treated in correctional settings are upper respiratory tract infections like bronchitis and skin infections, such as cellulitis. Some settings, especially jails, have high levels of sexually transmitted diseases, as well. More challenging infections are often treated with intravenous antibiotics that require a stay in the infirmary or a trip to the hospital.

Common Antibiotics Used in Corrections

Commonly used antibiotics for respiratory and skin infections are

• Amoxicillin (Amoxil)
• Azithromycin (Z-Pak)
• Cephalexin (Keflex)
• Levofloxacin (Levaquin)
• Trimethoprim (Bactrim)

Commonly used antibiotics for sexually transmitted diseases are

• Azithromycin – Gonorrhea
• Ceftriazone – Gonorrhea
• Penicillin G Benzathine (Bicillin)- Syphilis

Antibiotic Side Effects

Side effects are a nursing concern for any medication; and antibiotics are no exception. Minor GI upset is common for many antibiotics so nausea, vomiting and diarrhea may emerge. However, the most serious concern with antibiotic use is allergic reaction. Allergic reaction can run a continuum from mild to life-threatening with the following options.

• Itching and rash
• Hives
• Angioedema
• Stephens-Johnson Syndrome (SJS)
• Toxic epidermal necrolysis
• Anaphylaxis

Best Practice for Antibiotic Treatment

When prescribing or administering antibiotic therapy, consider these best practices.

• Double check for any drug allergy before giving the first dose of any antibiotic. Anaphylaxis is no light matter and a real concern with antibiotic use.
• Use the shortest duration of therapy possible.
• Match the bug with the drug. Prescribers should know the likely microorganism, disease presentation, and individual patient characteristics when determining appropriate antimicrobial therapy.
• Avoid use of broad-spectrum antibiotics, when possible. Target antibiotic choice to the likely microorganism.
• Keep close tabs on the patient, if the prescribed antibiotic is not working, culture or re-culture the infection to more appropriately identify the infecting pathogen.

Watch for These Red Flags

As a correctional clinical pharmacist, Dr. Ford has seen many an antibiotic order cross his bench. Here are the practices that raise a flag for closer attention.

• Excessive duration of therapy: Most infections should be treated in 14 days or less
• Duplicate coverage: using two similar antibiotics such as amoxicillin and cephalexin for the same infection.
• Inappropriate usage: treating a MRSA infection with a cephalosporin (MRSA, by definition, is resistant to cephalosporins)

By implementing best practices and avoiding red flag actions, infections can be effectively treated in the correctional setting.

What has been your experience with bugs and drugs in your facility? Share your thoughts in the comments section of this post.

This post is part of a series discussing topics addressed during sessions of the 2017 Spring Conference on Correctional Health Care. All posts in this series can be found HERE.