It’s a case, says Terry Dwelle, of being vigilant, judicious and smart. And perhaps, most importantly of all, of coming out from behind the barricades and silos and working together. That’s his prescription for dealing with antibiotic-resistant pathogens.
Dwelle is a pediatrician and infectious disease expert serving as the state health officer in North Dakota for the past 12 years. What’s more, he’s a rancher and has international health care experience, having served in healthcare clinics in Africa. However, it is from the perspective of a public health official that he suggests four tactics to consider as the U.S. struggles to manage a growing concern about antibiotic-resistant pathogens.
“Number one, public information campaigns may be something we should consider to inform the public regarding inappropriate antibiotic use and the adverse effects,” he says. “What we want to do is change, if we can, public expectations (about antibiotic use) and make them more appropriate.”
Next, he says intensive informational campaigns for physicians and veterinarians alike need to be considered, with the same goal in mind – establish a mindset of appropriate and judicious antibiotic use. In Denver, he says, a program that focused on clinicians and the public resulted in a decrease from 74% to 48% in the antimicrobial usage for bronchitis with no change in the control group.
“The third thing we might be able to do is (establish) proactive hospital usage programs,” he says. In fact, such programs might be the easiest part of the equation, because doctors have complete control over antibiotic use and a hospital can put teeth in its antibiotic use policies.
“When you get to the clinics, I don’t know exactly how we’re going to do that,” he says. “A question I would have for our veterinarian colleagues is would there be some proactive policy things we can do to help clinicians better use antibiotics?”
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Hospital campaigns work, he says, because he saw it happen when he was working as an infectious disease specialist in a Bismarck hospital. There, he established a program to help doctors make appropriate and judicious choices when ordering antibiotic treatments. “In a matter of 6-8 weeks, the appropriate use of broad-spectrum antibiotics increased to 95%, and we started to see a downturn in resistance patterns of the organisms we were dealing with,” he says.
The fourth thing he suggests is this: “Maybe it’s time for us to have a little more collaboration and partnership work to talk about things.” He is chair of the Infectious Disease Policy Committee for the Association of State and Territorial Health Officials. “I know I speak for my committee,” he says. “We would be greatly interested, if there is interest from other parties, in getting together to talk about how public health, human medicine and veterinary medicine can work together on a comprehensive program to hopefully deal with resistance issues.”
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