‘We Can All be Antimicrobial Stewards’


A paradigm shift is emerging when it comes to the clinical approach to prescribing antibiotics. One clinician weighs in on using this class of therapeutics more judiciously.

Jasmine Marcelin, MD, FACP, FIDSA, associate professor, Department of Internal Medicine, associate medical director, Antimicrobial Stewardship Program, University of Nebraska Medical Center, says there are a number of instances where patients present with bacterial infections and their antibiotic regimens can be reduced.

“Shorter is better,” is a maxim being considered in clinical circles when it comes to thinking about antibiotic durations. Investigators are studying therapies that may have traditionally been used for 10-14 days and can be reduced by several days. Marcelin says there is more data supporting this decrease in duration and can be a strategy for stewardship.

She believes all clinicians can be stewards. “There are a lot of different ways we can all be antimicrobial stewards in the hospitals and clinical settings,” Marcelin said.

Marcelin presented a scientific session, Antibiotic Abuse: Making the Right Call With Antibiotics, at this week’s ACP conference being held in San Diego.

In addition, Marcelin says the delivery of therapies is another strategy that helps in this area. For example, transitioning inpatients from an IV administration to oral antibiotics has a couple of distinct advantages including releasing patients earlier so they can be home in a comfortable setting as well as not expecting any complications with an early release. “There’s a lot of good data that for certain syndromes that we can switch a person to oral antibiotics and there isn’t going to be any increases in recurrences of those infections or adverse events.”

Another significant component to this stewardship strategy is counseling patients when they visit their providers, especially when the former is expecting to get a prescription for an antibiotic even though they may not have a bacterial infection. When a patient has a viral infection, Marcelin says this is an opportunity to explain to patients an antibiotic is not warranted but that watchful waiting is the best course of action.

Contagion spoke to Marcelin at the conference about her session, specific examples where therapy regimens can be reduced, and counseling patients when antibiotics should be withheld.

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