Peter Currie, MD: Stories of Antibiotic Use and Resistance

As an Emergency Physician, I prescribe antibiotics on a daily basis for routine and complex infections.

The most challenging thing is balancing many competing interests. In the Emergency Department, we need to make decisions often based on limited information and in a timely manner. Additionally, educating patients about antibiotics, and the issues around their use, is time-consuming; many patients start with pre-conceived notions based on how they’ve been treated in the past which may not reflect current realities or practices.

Even in my career, I’ve seen resistance patterns change, such that antibiotics that were effective only years ago are no longer good choices. It’s incredible, and a bit disconcerting, to actually “see” it happening.

It has made antibiotic selection for our most complex patients, those with serious infections, and many other medical illnesses, more challenging. Even for patients with simple, common infections, other factors like pregnancy, allergies, and side effects, compound the complexity of antibiotic selection. We work closely with a clinical pharmacist for help with the difficult cases.

Of course, the worst case scenario is a common infection that causes significant harm and for which we might no longer have an effective antibiotic. This has seemed far-fetched, but as the development of resistance seems to be out-pacing the development of new antibiotics, it seems more and more realistic.

My sense is that even with greater scrutiny and care, we still prescribe antibiotics too often. So a greater understanding of which conditions benefit from antibiotics, and specifics like how much and how long and how often, could really help us focus our antibiotic use on those patients and conditions that truly benefit, while limiting harm to those who don’t.