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Priya Nori, MD, medical director of Antimicrobial Stewardship, at Montefiore Health System, joins to discuss U.S. Antibiotic Awareness Week (Nov. 18-24). Dr. Nori details the harms of antibiotic and anti fungal overuse, the steps health systems can take to help physicians use antimicrobials appropriately and the holistic efforts that are needed to combat antimicrobial resistance. AMA Chief Experience Officer Todd Unger hosts.
- CDC resources for Antibiotic Awareness Week.
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- Priya Nori, MD, medical director, Antimicrobial Stewardship, Montefiore Health System
Unger: Hello and welcome to the AMA Update video and podcast. In this episode, we'll be discussing the U.S. Antibiotic Awareness Week and what physicians need to know about it. I'm joined today by Dr. Priya Nori, medical director of Antimicrobial Stewardship at Montefiore Health System in the Bronx, New York. I'm Todd Unger, AMA's chief experience officer in Chicago. Welcome Dr. Nori.
Dr. Nori: Hi, good morning. Thank you for having me.
Unger: Well before we dive into our discussion, why don't we just start with a brief overview of Antibiotic Awareness Week?
Dr. Nori: Sure, I'd be happy to. So Antibiotic Awareness Week occurs annually around the third week of November. And this week is meant to really educate the public about the harms of antibiotic and antifungal overuse, and really drive home the point about antibiotic use in all sectors whether it's health care, inpatient, outpatient, dental clinics, agriculture, you name it. It is all linked and it all has an impact on human health.
Unger: And Antibiotic Awareness Week gives medicine an opportunity to come together on what is a very important issue. I see the picture behind you of bacteria. We want to continue to have antibiotics be effective in that case. What are three things that you think all physicians should focus on in the coming year?
Dr. Nori: Yes, that is a great question. Thank you for raising it. So the first thing is that, kind of goes back to what I said before, which is that antibiotic use, no matter where and for what purpose, it not only impacts that particular person but it can impact everyone around them. Even use in somebody's dog or pet or use in agriculture can ultimately come back and impact human beings.
So we're truly all connected when it comes to things like antibiotic antifungal use. And so taking a one health lens when we think about antimicrobial resistance is very important. So that's the first thing.
The second thing is that antimicrobial resistance will become one of the major issues of our lifetimes if it's not already. So by 2050, it will have claimed many, many lives. And therefore we should really prioritize it on the same level as cancer or cardiovascular disease.
The third one is that we have to intensify our focus on equity. And so not all antimicrobial resistant infections are created equal in that certain vulnerable populations are going to be at increased risk of harm and even death than others. And these include individuals who are marginalized, who are of poor socioeconomic backgrounds, patients or individuals who live in low and middle income countries, patients who are displaced by other events crises around the world.
This is where antimicrobial resistant infections are taking root more and more. And so we have to protect our most vulnerable when it comes to antimicrobial resistance.
Unger: You know I've had a chance to speak with a lot of different physicians about equity issues. That is not one that I've heard before. Talk to us a little bit more about what does it mean to address equity in terms of antibiotic use and resistance?
Dr. Nori: So it is not enough to approach patient care from the lens of 'Well I'm going to do exactly the same thing in every patient and therefore I'm maintaining equity,' or 'I am not discriminating based on somebody's background or language,' et cetera.
We really have to intensify access to care, intensify access to diagnostics and treatments for patients who may not have the same level of access, who may not speak our language, who are at increased risk of these infections to begin with.
So it's not only enough to treat everyone the same but we really have to do what we can to pull others up and to level the playing field when it comes to outcomes from these really terrible infections.
Unger: Thank you for that perspective. In your role at Montefiore, it must feel like Antibiotic Awareness Week every day. Curious what some of the practices are that you've put into place to ensure that antimicrobials are used appropriately where you work.
Dr. Nori: It's a great question, thank you for that. So I work with a large team of infectious diseases pharmacists. So infectious disease docs and pharmacists are partners in this and we oversee programs called Antimicrobial Stewardship programs.
And so what we do is we try to teach everyone how best to use these drugs. But we also try to put into place technological advances that really upgrade the day-to-day lives of everyday physicians and nurses and trainees.
And so when you're dealing with thousands of patients in the hospital, huge hospital systems, really the best way to do these things in the modern era is to create decision support tools in the electronic record where they go to treat a certain type of infection or they go to order a certain antibiotic. And we teach them, we build in alerts or language right there in the computer that say this is the dose you give. This is for how long for this infection. Actually have you considered this antibiotic instead because the patient has this and you could probably get away with using something a little bit more narrow in spectrum.
And so we have to respect how doctors and nurses work these days. We have to respect their heavy dependence on technology and bring these tools to where they're at to the bedside. And so that's really our approach at my program.
Unger: So you're kind of building in that support right into your technology so to speak.
Dr. Nori: Exactly and phones. We rely heavily on smartphone apps that actually teach patients, sorry, teach providers about what infections a patient may have and therefore what test to order and what antibiotics to give to treat that infection.
So we, in the same way somebody might refer to a Google search or a ChatGPT search, we try to bring those tech advances right to their phones and their devices.
Unger: Excellent. Dr. Nora, you mentioned also that Antibiotic Awareness Week was really about teaching the public about use of antimicrobials and resistance. That's tough. Reaching the public with anything in terms of all of the messages that they're getting not even just related to health care but everything makes it a real challenge.
What are you finding particularly challenging about reaching the public with this message?
Dr. Nori: So I'm actually, I'm going to flip that a little bit. And I'm going to take a challenge that we had that we really dealt with great intensity over the past three years, which is COVID. And then I'm going to use that to talk about educating the public about antibiotic awareness.
So with COVID, one of the things that we gained from that experience, as harrowing as it was, was the awareness of the public about what is a virus and what is not a virus. So now we can harness their increased awareness about this to continue to spread awareness about the fact that antibiotics do not treat viruses. And they know this now very well because they know that only certain medications treat a virus like COVID but certain other ones really do not.
And so I say let's take lemons and turn them into lemonade. And let's continue this dialogue with our public to say here's how to prevent infections with vaccines. And here's what to give and here's what not to give. And so really it is viral infections like the common cold, flu that are driving overuse of antibiotics especially in the outpatient setting.
So now we can be on the same page more so with patients and parents and families to say your child's symptoms are caused by a virus. And so let's avoid use of antibiotics because they're not totally benign. They can have their side effects. And so therefore let's give this set of drugs instead of that set of drugs. I hope that makes sense.
Unger: It does, totally. Well you've given us a lot to think about this week. Over the next year, Dr. Nori, what's one area you'd like to see the most progress in related to antimicrobial use?
Dr. Nori: Yes, thank you for that question, I'm so excited about it. So I would like to take more of a one health approach in how we address really all of the crisis that we're currently dealing with. I don't see antimicrobial resistance as separate from the risk of climate change and human health or so many other crises that we're dealing with, displaced peoples, et cetera, conflicts.
Antimicrobial resistance is at the root of all of these things. All of those other crises will worsen antimicrobial resistance. So we have to come at these problems from a collaborative, multidisciplinary way and realize that they're all linked and we can't really put them in silos.
So what that means is going big with policies that address all of these things, going big with funding and public awareness campaigns. And really this is to protect the health of future generations, existing generations but creating a better environment for us to be able to exist for the many, many years to come.
Unger: Dr. Nori, thank you so much for joining us and giving us the background on Antimicrobial Awareness Week. Such important information for both physicians and patients out there.
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You can always find all our videos and podcasts at ama-assn.org/podcasts. This is our last episode before we break for the Thanksgiving holiday. And in the meantime have a safe and healthy holiday.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.