What’s a good steward of antibiotics prescribing?

Newest pharmacists to join collaborative effort focus on correct uses, doses and durations of antibiotics
Jan. 24, 2017

Bacteria is a tricky culprit, and UCHealth has only their best detectives on the case.

Lisa Costanigro is UCHealth’s newest pharmacist to join the Antimicrobial Stewardship Collaborative, an effort focusing on managing antibiotic prescribing and promoting antibiotic stewardship as part of everyday clinical practice.

Antibiotics have been incredibly helpful through their history. The discovery of the antibiotic penicillin in the 1920s helped cure bacterial infections and led the way for other discoveries. But according to the Centers for Disease Control and Prevention, unnecessary or inappropriate antibiotic uses — such as prescribing the wrong agent, dose or duration — is a concerning issue affecting antibiotics’ sustainability and effectiveness in healing people.


Findings, like the person carrying a strain of E. coli resistant to colistin, the last-resort antibiotic for particularly dangerous types of superbugs, continues to stir concern and spark initiatives like the Antimicrobial Stewardship Collaborative.

“To improve patient outcomes, we need to use antibiotics wisely to preserve their efficacy,” Costanigro said.

Antibiotics work against infections caused by bacteria and certain parasites, most often by interfering with the structure of the cell wall of the bacterium or parasite and other times by stopping it from multiplying.

Antibiotics don’t work against viruses, such as the flu or common cold.

But remember, bacteria is a tricky culprit; it has the ability to become resistant to the drugs created to kill it.

“The use of antibiotics is the single most important factor leading to antibiotic resistance around the world,” according to the CDC. “Simply using antibiotics creates resistance.”

This is where Costanigro comes in. Her role is to comb through drug records to determine if patients are getting the correct antibiotic, the right amount and for the right duration. She’s tasked with educating patients and providers on the importance of being stewards of antibiotics, and she’s to create processes to support these efforts.

She’s focusing on three main themes to get started: misuse of broad-spectrum antibiotics, education on the importance of correct antibiotic durations and performing antibiotic time outs.

Costanigro combs through prescription orders found in UCHealth’s electronic medical records, scrutinizing some orders more than others, she said.

There are about 40 different antibiotics that can be prescribed at UCHealth hospitals.

“Some antibiotics have a larger risk for resistance than others, so we want to preserve them for appropriate uses,” she said. “And then other antibiotics cover a wide range [aka, broad-spectrum], so I want to make sure there isn’t a narrower treatment option we could use.

“The whole thing is about optimizing treatment,” she continued. “Sometimes an organism isn’t covered by the antibiotic prescribed or it’s not the best dose, agent or duration. And if this happens, there are risks.”

Antibiotics are among the most commonly prescribed drugs in medicine but the CDC said that up to 50 percent of the time in acute-care hospitals, they are improperly prescribed.

Antibiotics not only kill bacteria causing the illness, they also can kill the good bacteria protecting the body from infection. This allows drug-resistant bacteria to take over, which can cause even more problems.

Clostridium difficile (C. diff) is one of the worst offenders. When something upsets the balances of organisms in the gut — like the use of a broad-spectrum antibiotic, multiple antibiotics or an antibiotic administered for too long a period of time — otherwise harmless bacteria, such as C. diff, can grow out of control, releasing toxins that attack the lining of the intestines and cause severe diarrhea.

According to the CDC, antibiotic resistance causes more than 23,000 deaths annually in the United States, and more than 2 million illnesses.

To go along with Costanigro’s monitoring and education within UCHealth’s northern Colorado hospitals, she plans to initiate an antibiotic time-out requirement — a re-evaluation of a patient’s ongoing antibiotics a set period of time after starting treatment.

A time-out would help initiate those questions, Costanigro added.

This objective is not new to UCHealth or to Costanigro, who’s been a pharmacist at UCHealth for more than eight years. Dosing protocols were first established by Gina Harper, coordinator of pharmacy services for UCHealth Northern Colorado, in 2009, and it is something all pharmacists at Poudre Valley Hospital and Medical Center of the Rockies, as well as UCHealth University of Colorado Hospital, monitor as part of their patient care tasks. But it wasn’t until now there was a dedicated pharmacist who focuses on the objective at UCHealth’s northern Colorado hospitals.

“Before there was this major drive, we were already doing these things,” said Dr. Jacob Liao Ong, infectious disease specialist and director of antimicrobial stewardship at UCHealth Northern Colorado. “Now everyone has that go-to person [Costanigro] for when they need help making the right choice in antibiotics, the right dose or want to know their options. It’s still a team effort and part of the pharmacists’ and infectious disease role, but Lisa is a very important tool in this program.”

About the author

Kati Blocker has always been driven to learn and explore the world around her. And every day, as a writer for UCHealth, Kati meets inspiring people, learns about life-saving technology, and gets to know the amazing people who are saving lives each day. Even better, she gets to share their stories with the world.

As a journalism major at the University of Wyoming, Kati wrote for her college newspaper. She also studied abroad in Swansea, Wales, while simultaneously writing for a Colorado metaphysical newspaper.

After college, Kati was a reporter for the Montrose Daily Press and the Telluride Watch, covering education and health care in rural Colorado, as well as city news and business.

When she's not writing, Kati is creating her own stories with her husband Joel and their two young children.