Robert Jacobson, MD: Stories of Antibiotic Use and Resistance

In my work as the medical director of the primary care immunization program at Mayo Clinic, my focus is on everyone getting their recommended vaccines on time. Routine vaccinations prevent bacterial infections and thus prevent the need for antibiotics. For example, everyone needs the flu vaccine every year. The flu vaccine prevents flu, which is viral, but the flu can often result in a secondary bacterial infection like middle ear infections, sinus infections, and pneumonia. Those hospitalized with flu are at higher risk for iatrogenic [healthcare-associated] illness or injury, which in turn may call for antibiotics.

Given my answer to the first question, if a part of stewardship is getting vaccinated on time, then the persistent problems of vaccine hesitancy, delay, and refusal are to me the most challenging problems to stewardship. We need people to take their health seriously and get the preventive care they need, that is evidence-based, so we can avoid unnecessary antibiotics!

The most common experiences for me as a primary care pediatrician is the resistance we see about 20% of the time when treating middle ear infections and urinary tract infections. We started with a targeted drug that works for most, but one time out of five we have to switch to a more expensive and often more difficult drug.

It has made me wary of treating middle ear infections in children older than two years unless they have significant symptoms that persist. It has made me insist on getting positive strep tests before treating sore throats.

I worry that we will have more and more super-bugs that we cannot treat with by-mouth medications or any medications at all.

I would like to know when I am facing a bacterial infection what we could have done to prevent the bacterial infection in the first place!