Intermountain Health researchers have received a grant to address the problem of antibiotic overuse and resistance in urgent care and outpatient clinics.

The $356,000 grant from Merck will launch the Intermountain ReSCORE-UC project, which will be a two-year study to better understand how to maintain proper antibiotic prescribing in outpatient settings. The goal is to ensure patients are getting the most effective care for their illnesses without being harmed by unnecessary antibiotics and possible side effects that can go along with their use.

“In the field of antibiotic stewardship, Intermountain Health has been a national leader,” said Dr. Payal Patel, enterprise medical director for antimicrobial stewardship at Intermountain Health and co-investigator on the study. “This grant will continue to put us at the forefront of understanding how we can make sure that we optimize antibiotic use in the urgent care setting to improve our prescribing rates, and also demonstrate to other health systems how they can do the same.”

Antibiotic resistance can happen when bacteria become stronger and no longer respond to treatment that was once effective. It can also happen when people take an antibiotic for the right reason but don’t finish it. This can cause some bacteria to die, and the rest to survive and multiply, and in turn become resistant to treatment.

Antibiotic medications are also not free from side effects. They can cause gastric distress, other infections such as clostridioides difficile (C. diff), a potentially serious intestinal infection causing bloody diarrhea and inflammation of the colon, allergic reactions, kidney and liver problems, muscle pain and even some mental health issues, including anxiety and depression.

The Centers for Disease Control and Prevention reports that in 2022 at least 28% of antibiotics given in outpatient settings were unnecessary. Globally, more than 2.8 million antimicrobial-resistant infections occur every year.

The challenge for clinicians, according to a press release from Intermountain Health, is that antibiotic prescriptions for respiratory infections remain too high in outpatient and urgent care settings. In more than 90% of cases, these medications don’t treat the infection for patients in these settings, which are often viral in nature and don’t respond to antibiotics.

While initiatives can help lower rates and bring the issue to the spotlight, the effect is usually temporary, and prescribing rates creep back up when the programs end.

“We really want to know what leads to behavior change to enhance antibiotic usage,” said Dr. Park Willis, a family medicine physician at Intermountain Health who is also a co-investigator and medical director for regional urgent care for Intermountain. “One of the key questions that we want to answer is: What processes do we need to implement that will lead to that long term effect and make it part of someone’s everyday thinking, and not just during a project?”

The new study will build off of the success of the previous Intermountain SCORE-UC initiative to reduce antibiotic overuse, which resulted in a 15% reduction in prescriptions in upper respiratory tract infections for patients in the organization’s 38 urgent care centers. Although the initiative was a success, the results weren’t permanent and antibiotic prescriptions have increased again.

“This is something that many health systems struggle with across the nation,” said Dr. Allen Seibert, an infectious disease specialist at Intermountain Health and principal investigator on the study. “We’ve seen some of those antibiotic prescribing improvements be much more challenging to really maintain.”

The new grant will also enable Intermountain researchers to study how antibiotic prescribing rates vary between different patient groups, including in racial and ethnic minorities, and in rural and urban settings.

“We can then see how we can redesign and reimplement antibiotic stewardship initiative to be more sustainable, durable and equitable in the long term,” Seibert said.

Intermountain Health researchers will also be working with Dr. Adam Hersh, a pediatric infectious disease expert at the University of Utah, and Julia Szymczak, Ph.D., a medical sociologist with expertise in the behavioral dynamics of antibiotic stewardship, with the goal of improving antibiotic stewardship across urgent cares in Utah and the Intermountain West.