Jonathan Alpern, MD: Stories of Antibiotic Use and Resistance

Every day, whether I am working in the clinic or in the hospital, I am answering questions related to antibiotics. On the Infectious Disease inpatient clinical service, we are frequently asked to provide input on the appropriate use of antibiotics for sick patients in the hospital. We also work closely with pharmacists to make sure that antibiotics are being used appropriately and stopped when they are no longer needed.

There is often a balancing act when it comes to antibiotic prescribing and stewardship—ensuring that the patient in front of us receives early, appropriate antibiotics for their infection, while also narrowing the spectrum of coverage and not overprescribing. Given the diagnostic uncertainty in medicine, this can be challenging.

As an infectious disease specialist, I am frequently asked to consult on patients who have infections with resistant bacteria. This is now becoming routine for infectious disease physicians.

As a result of antibiotic resistance, a common clinical question that we receive is regarding what antibiotic to use for the organism that has grown in culture. My job is to then determine the significance of this culture result and whether or not it represents a true infection for that patient. This is an aspect of my job that I find very rewarding.

I think a concern that many of us have is that we are not keeping pace with antibiotic resistance. Combating this successfully will require an improvement in incentives and opportunities for pharmaceutical companies to bring novel antimicrobial drugs to market, and continued antimicrobial stewardship efforts.

We are learning more about the risk of travel when it comes to colonization with multi-drug resistant pathogens. After removing the risks associated with antibiotic use and other travel-related behaviors, which groups of travelers are the most "high-risk" when it comes to the development of antimicrobial resistance?