Get Smart: Know When Antibiotics Work

http://www.icares.org/

1. To expand the Indiana Coalition for Antibiotic Resistance Education Strategies (ICARES) coalition to include nurses, teachers and other community members throughout Indiana to better serve the needs of health care professionals and the public.
2. To plan and implement a community-wide health fair/seminar in the spring of 2006 using a multigenerational, bilingual approach to address appropriate antibiotic use, issues related to antibiotic resistance, medication safety, and hand washing.
3. To encourage increased involvement of the health care providers (physicians, pharmacists, nurses) throughout Indiana to educate their patients about issues related to antibiotic resistance and about the appropriate use of antibiotics.
4. To utilize the Indiana libraries, theatre venues and on-hold phone service to increase access of the appropriate antibiotic use literature to parents, childcare providers and others.
5. To continue to track trends of new retail oral antibiotic sales. This will enable Marion County Health Department (MCHD) and the Indiana State Department of Health (ISDH) to continue to track overall level of use, along with observing trends that may suggest overuse of specific agents in any area or areas in Indiana.

Since 2002, the Marion County Health Department (MCHD) and the Indiana State Department of Health (ISDH) has partnered with ICARES. Our common goal is to expand appropriate antibiotic use education activities through physician's offices, pharmacies, hospitals, and other health care providers, as well as the public throughout Indiana.

Provider Education
	All Indiana physicians (family practice, ER, pediatrics, OB/GYN), in over 2400 offices, were provided the new treatment guidelines for otitis media and pediatric and adult treatment guidelines for upper respiratory infections. This information will help healthcare providers to educate their patients about the appropriate use of antibiotics and to offer active management of acute respiratory infection (ARI) symptoms. Physician offices are provided free patient education materials by ICARES partners. ICARES partners encourage physicians to educate their patients about the expected timeline for their illness and to give specific follow-up instructions.
Patient Education & Public Education:
	Eighty-one of the 240 Indiana libraries were provided with a copy of the book titled, The Little Elephant with the Big Earache. This book provides a common sense explanation of a doctor visit, a parent's reaction to a child's illness, and a sensible course of treatment. Eddie, the little elephant with the big earache, will help children 2-7 years old understand a lot of things about being sick. The Little Elephant with the Big Earache is a great book for story time and it will provide comfort and a little humor when a child is feeling a little under the weather, especially during cold and flu season. Dr. Charlotte Cowan, M.D., pediatrician and author, emphasizes that antibiotics are not always the best option for ear infections. This book can help parents to avoid unnecessary visits to the emergency room, taking unnecessary antibiotics, and help to decrease medical costs. This book was highlighted during the month of October 2005 in the 81 libraries. Three hundred six children and over 90 parents were read this book during story time in the participating libraries.
	Six of the thirteen Marion County Head Start locations were presented with appropriate antibiotic use information at parent meetings. In April 2006, all Indiana Head Start locations will be offered the opportunity to receive the Question & Answer sheet for appropriate antibiotic use and the Parent brochure for each child's guardian.
	With the help of the Butler Pharmacy students, eleven senior locations in Marion County received information about medication safety, which includes appropriate antibiotic use.
	A new brochure was developed with the new " observation option " information. This brochure is titled, Childhood Ear Infections. This brochure will be provided free to physician's offices (pediatrics and family practice) and at health fairs throughout Indiana. Also, in collaboration with the public health nurses of Marion County, appropriate use of antibiotics information was put on the back of their handout " What to do now that your child has had his shots. " An activity book, Stop the Spread of Germs, has been developed. This booklet targets kindergarten through third grade and emphasizes hand washing and covering your cough to stop the spread of germs.

Penicillin non-susceptibility in Streptococcus pneumoniae in Indiana showed a decrease from 2000 (31.6%) to 2001 (30.8%) to 2002 (24.4%). In 2003, 25% were non-susceptible (522 isolates tested). In 2004, 28% were non-susceptible (485 isolates tested, which includes Marion County ).

The ICARES' Appropriate Antibiotic Use program has reached parents, children, and health care professionals throughout the state of Indiana. A total of 156,673 pieces of patient education materials, including brochures and posters in English and Spanish, day care letters, question and answer sheets, and bookmarks were requested and received.

This year (2006) ICARES will purchase two years of MSA level state data for all oral antibiotic sales for retail pharmacies, reported monthly for a two-year period, from June 2004 to June 2006 for use in evaluation, as an indicator of the level of use of antibiotics in our state. In addition to helping us track overall level of use, we should also be able to see trends suggesting overuse of specific agents.

The issue of appropriate use of antibiotics does not seem to be a total novelty to many at health fairs. Many admit to hearing something about appropriate antibiotic use or antibiotic resistance either from their doctor, literature, or on the news. It is clear that prevention will have to be a major part of educating the public about the fight against germs and bacterial resistance. This will include hand washing, environmental cleaning techniques, and the appropriate way to follow through with taking antibiotics.