Understanding Antibiotics: How They Work, When to Use Them and What to Avoid

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• Antibiotic Allergy: Accurately document type (IgE-mediated vs. non-IgE like rash). Avoid unnecessary avoidance of Beta-lactams. Consider allergy testing/desensitization if critical. Use alternatives cautiously (e.g., Clindamycin has higher C. diff risk; Vancomycin requires monitoring).
• Renal Dosing: Adjust doses for renally cleared antibiotics (Penicillins, Cephalosporins, Vancomycin, Aminoglycosides, TMP-SMX, Fluoroquinolones). Use calculators/Cockcroft-Gault formula. Monitor levels (Vancomycin, Aminoglycosides).
• Hepatic Dosing: Adjust for hepatically metabolized/cleared antibiotics (Macrolides, Metronidazole, Rifampin, some Azoles). Monitor LFTs if prolonged therapy.
• Pregnancy: Choose safest options (Penicillins, Cephalosporins, Erythromycin, Azithromycin). Avoid Tetracyclines, Fluoroquinolones, Aminoglycosides (unless severe), Sulfonamides (near delivery – risk kernicterus), Metronidazole (1st trimester – controversial). Dose adjustments needed.
• Pediatrics: Weight-based dosing is mandatory. Avoid certain drugs (Tetracyclines <8yrs, Fluoroquinolones – except specific indications). Liquid formulations often needed.
• Obesity: Dosing based on total body weight (TBW) or adjusted body weight (AdjBW) varies by antibiotic (e.g., Vancomycin, Aminoglycosides use TBW; many Beta-lactams use AdjBW). Consult guidelines/pharmacy.
• Antibiotic Resistance: The constant threat. Prescribe narrowly, use shortest effective duration, utilize local antibiograms, employ infection control measures, support antimicrobial stewardship programs (ASPs).

The Role of Antimicrobial Stewardship Programs (ASPs)

ASPs are multidisciplinary teams (infectious diseases physicians, pharmacists, microbiologists, infection control, epidemiologists) dedicated to optimizing antibiotic use. Key functions include:

• Developing evidence-based guidelines & formulary restrictions.
• Prospective audit and feedback on prescriptions.
• Education for prescribers and patients.
• Monitoring resistance patterns and antibiotic consumption.
• Implementing rapid diagnostics.
• De-escalation and IV-to-oral switch interventions.

All prescribers should actively engage with and support their institution’s ASP.

Conclusion: Precision as a Professional Responsibility

Prescribing antibiotics is not merely writing a prescription; it is a complex clinical decision demanding diagnostic rigor, therapeutic precision, and constant vigilance. The “right way” involves:

1. Confirming bacterial necessity before initiating therapy.
2. Selecting the narrowest effective spectrum based on likely pathogens and local resistance.
3. Optimizing dose, route, and duration for the specific patient and infection.
4. Relentlessly reviewing and de-escalating therapy based on clinical response and microbiology.
5. Educating patients thoroughly.
6. Embracing stewardship principles to preserve these life-saving drugs for future generations.

The consequences of imprecise prescribing extend far beyond the individual patient, fueling the AMR crisis that threatens modern medicine. By adhering to these principles and continuously updating knowledge, clinicians fulfill their dual responsibility: providing optimal care to the patient in front of them while safeguarding the effectiveness of antibiotics for all. The right prescription is not just effective; it is responsible.

FAQs

1. What are antibiotics and how do they work?

Antibiotics are medications that fight bacterial infections by either killing bacteria or inhibiting their growth. They work by targeting specific structures or functions essential for bacterial survival, such as cell wall synthesis, protein production, or DNA replication.

• Can antibiotics treat viral infections like the flu or common cold?

No, antibiotics are only effective against bacterial infections. Viral infections like the flu, common cold, and most sore throats do not respond to antibiotics. Using antibiotics for viral infections contributes to resistance and causes unnecessary side effects.

• Why is it important to finish the entire course of antibiotics even if I feel better?

Completing the full course ensures that all bacteria causing the infection are eliminated. Stopping early can allow surviving bacteria to develop resistance and cause the infection to return, potentially with more resistant strains.

• What is antibiotic resistance and why is it dangerous?

Antibiotic resistance occurs when bacteria evolve mechanisms to withstand the drugs designed to kill them. This makes infections harder to treat, increases the risk of severe illness and death, and can lead to the spread of resistant bacteria to others.

• Can I share my antibiotics with someone else who has similar symptoms?

No, antibiotics should only be used by the person for whom they were prescribed. Sharing antibiotics can lead to inappropriate treatment, contribute to resistance, and cause harmful side effects in the other person.

• Are there natural alternatives to antibiotics?

While some natural substances have antimicrobial properties, they are not proven alternatives to prescription antibiotics for treating bacterial infections. Natural remedies should not replace prescribed antibiotics for serious infections.

• How do I know if I need antibiotics for my illness?

A healthcare provider can determine whether antibiotics are necessary based on your symptoms, physical examination, and sometimes diagnostic tests. Not all infections require antibiotics, and many resolve on their own.

• What are the most common side effects of antibiotics?

The most common side effects include gastrointestinal issues like nausea, vomiting, diarrhea, and abdominal pain. Other possible side effects include allergic reactions, yeast infections, and sensitivity to sunlight, depending on the antibiotic.

• Can antibiotics interact with other medications?

Yes, antibiotics can interact with many other medications. For example, some antibiotics can reduce the effectiveness of birth control pills, while others can interact with blood thinners or heart medications. Always inform your healthcare provider about all medications you take.

1. Is it safe to take antibiotics during pregnancy?

Some antibiotics are safe during pregnancy, while others should be avoided. Penicillins, cephalosporins, and erythromycin are generally considered safe, but always consult your healthcare provider before taking any medication during pregnancy.

1. How long does it take for antibiotics to start working?

Most antibiotics begin working within 24 to 48 hours, though you may not feel better immediately. Improvement in symptoms typically occurs within a few days, but this depends on the type and severity of the infection.

1. Can I drink alcohol while taking antibiotics?

Alcohol does not reduce the effectiveness of most antibiotics, but it can increase side effects like nausea and vomiting. Some antibiotics, like metronidazole and tinidazole, can cause severe reactions when combined with alcohol.

1. What should I do if I miss a dose of antibiotics?

If you miss a dose, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not double up on doses to make up for a missed one.

1. Are broad-spectrum antibiotics better than narrow-spectrum ones?

Not necessarily. Broad-spectrum antibiotics affect a wide range of bacteria, including beneficial ones, while narrow-spectrum antibiotics target specific bacteria. When possible, narrow-spectrum antibiotics are preferred to minimize disruption to the body’s natural microbiome and reduce resistance development.

1. Can antibiotics cause long-term health problems?

While most side effects are temporary, some antibiotics can have long-term effects. For example, fluoroquinolones have been associated with permanent nerve damage and tendon ruptures. Antibiotics can also alter the gut microbiome for months or years after treatment.

1. How can I prevent infections that might require antibiotics?

Preventive measures include vaccination, regular handwashing, safe food handling, practicing safe sex, and maintaining good overall health through proper nutrition and exercise.

1. What is C. diff infection and how is it related to antibiotics?

Clostridioides difficile (C. diff) is a bacterium that can cause severe diarrhea and colitis, often after antibiotic use. Antibiotics disrupt the normal gut bacteria, allowing C. diff to overgrow. This infection can be life-threatening and requires specific treatment.

1. Are there antibiotics that children should not take?

Yes, some antibiotics are not recommended for children. For example, tetracyclines can cause permanent tooth discoloration in children under eight, and fluoroquinolones may affect bone development. Healthcare providers consider age when prescribing antibiotics.

1. How are antibiotics used in livestock and how does this affect humans?

Antibiotics are used in livestock to treat infections, prevent disease, and promote growth. This use can lead to resistant bacteria that can spread to humans through food, water, or direct contact, contributing to the overall burden of antibiotic resistance.

• What is antibiotic stewardship?

Antibiotic stewardship refers to coordinated efforts to improve and measure the appropriate use of antibiotics. This includes ensuring the right drug, dose, and duration for each patient, while minimizing unnecessary use and combating resistance.

• Can I become allergic to antibiotics even if I’ve taken them before without problems?

Yes, it’s possible to develop an allergy to antibiotics at any time, even if you’ve taken them safely in the past. Allergic reactions can range from mild rashes to severe anaphylaxis.

• How do healthcare providers decide which antibiotic to prescribe?

Providers consider factors like the type of infection, likely bacteria, local resistance patterns, patient allergies, other medications, and the patient’s age and overall health. Sometimes, they start with a broad-spectrum antibiotic and adjust based on test results.

• Are there new antibiotics being developed?

Yes, but the pipeline is limited. Developing new antibiotics is challenging and less profitable for pharmaceutical companies compared to drugs for chronic conditions. However, efforts are underway to incentivize antibiotic development.

• What should I do with leftover antibiotics?

Leftover antibiotics should be properly disposed of at a pharmacy take-back program or according to local guidelines. Do not save them for future use or flush them down the toilet, as this contributes to environmental contamination.

• Can antibiotics affect birth control pills?

Some antibiotics, particularly rifampin, can reduce the effectiveness of hormonal birth control pills. While most antibiotics do not significantly affect birth control, it’s best to use a backup method of contraception while taking antibiotics and for a week after.

• How can I support my gut health while taking antibiotics?

Taking probiotics (several hours apart from antibiotics), eating fermented foods, staying hydrated, and consuming a fiber-rich diet can help support gut health during and after antibiotic treatment. However, always consult your healthcare provider before starting any supplements.

• What is the difference between bactericidal and bacteriostatic antibiotics?

Bactericidal antibiotics kill bacteria directly, while bacteriostatic antibiotics inhibit bacterial growth and reproduction, allowing the immune system to eliminate the remaining bacteria. The choice depends on the infection and patient’s immune status.

• Can antibiotics cause depression or anxiety?

While not common, some antibiotics have been associated with neuropsychiatric side effects like depression, anxiety, and confusion. If you experience mood changes while taking antibiotics, contact your healthcare provider.

• How does antibiotic resistance spread between people?

Resistant bacteria can spread through direct contact with infected individuals, contaminated surfaces, or through the air in healthcare settings. Poor hygiene and infection control practices facilitate this spread.

• What can I do personally to help combat antibiotic resistance?

You can help by taking antibiotics only when prescribed and exactly as directed, never sharing or saving antibiotics, preventing infections through vaccination and good hygiene, and advocating for responsible antibiotic use in your community.

• What is the single most important factor before prescribing an antibiotic?

Confirming the infection is bacterial or highly likely to be bacterial. Prescribing antibiotics for viral infections is the most common error and a major driver of resistance.

• When should I obtain cultures before starting antibiotics?

Always obtain cultures (blood, sputum, urine, wound, etc.) before starting antibiotics in cases of: severe infection (sepsis, meningitis), immunocompromised patients, infections with high risk of resistant pathogens (e.g., healthcare-associated), treatment failures, or when a precise diagnosis is uncertain. For uncomplicated infections like cystitis in healthy women, cultures are often not needed initially.

• What does “de-escalation” of antibiotics mean?

De-escalation refers to narrowing the antibiotic spectrum or switching from IV to oral therapy based on clinical improvement and/or availability of culture and sensitivity results. It’s a core stewardship principle to reduce resistance and side effects.

• How do I choose between a broad-spectrum and narrow-spectrum antibiotic?

Start as narrow as possible based on the most likely pathogen(s) for the specific infection site and patient factors. Use broad-spectrum antibiotics empirically only when: infection is severe/life-threatening, there are risk factors for resistant pathogens (e.g., recent hospitalization, prior antibiotics), or the infection is polymicrobial (e.g., intra-abdominal, diabetic foot). Always aim to de-escalate later.

• What is the standard duration for common infections like community-acquired pneumonia (CAP) or uncomplicated cystitis?

For CAP in non-ICU patients: Minimum 5 days, often extending to 7 days. For uncomplicated cystitis in women: Nitrofurantoin 5 days, TMP-SMX 3 days, Fosfomycin single dose. Shorter courses are increasingly supported by evidence for many infections.

• Should I always cover for MRSA empirically in skin infections?

No. Only cover empirically for MRSA in cellulitis/abscess if specific risk factors exist: recent MRSA infection/colonization, recent hospitalization/surgery, residence in long-term care facility, IV drug use, or failure of standard beta-lactam therapy. For uncomplicated cellulitis without risk factors, anti-streptococcal coverage (e.g., Cephalexin) is usually sufficient.

• How do I manage a patient with a reported penicillin allergy?

First, clarify the nature of the reaction (true IgE-mediated anaphylaxis/angioedema vs. non-IgE rash). True IgE allergy is less common than reported. For non-severe reactions, consider testing or graded challenge. If true allergy exists, choose alternatives cautiously (e.g., Cephalosporins have low cross-reactivity risk with 3rd/4th gen; Clindamycin, Vancomycin, TMP-SMX, Fluoroquinolones are options but have their own risks). Avoid unnecessary avoidance of beta-lactams.

• What antibiotics require renal dose adjustment?

Common renally cleared antibiotics needing dose adjustment include: Penicillins (e.g., Penicillin G, Ampicillin, Piperacillin), Cephalosporins (e.g., Cefazolin, Ceftriaxone, Cefepime – though Ceftriaxone is less dependent), Vancomycin, Aminoglycosides (Gentamicin, Tobramycin), TMP-SMX, Fluoroquinolones (Ciprofloxacin, Levofloxacin), Acyclovir, Ganciclovir. Use estimated creatinine clearance (eCrCl) and consult dosing guidelines.

• When are fluoroquinolones (e.g., Ciprofloxacin, Levofloxacin) appropriate?

Reserve fluoroquinolones for situations where no safer alternative exists or the benefit outweighs the risks (tendon rupture, neuropathy, aortic dissection, C. diff, QT prolongation). Appropriate uses include: Complicated UTIs/pyelonephritis (especially if resistant pathogens), bacterial prostatitis, specific intra-abdominal infections (with metronidazole), anthrax, plague, and sometimes as second-line for CAP or sinusitis if other options fail/contraindicated. Avoid for uncomplicated cystitis, sinusitis, or bronchitis.

• How do I treat asymptomatic bacteriuria (ASB)?

Do not treat ASB except in specific populations: Pregnant women (treat to prevent pyelonephritis/low birth weight), Patients undergoing urologic procedures with anticipated mucosal bleeding (e.g., transurethral resection), Renal transplant recipients within the first 6 months post-transplant. Treating ASB in catheterized patients, diabetics, or the elderly increases resistance and side effects without benefit.

• What is the role of procalcitonin (PCT) in antibiotic prescribing?

Procalcitonin is a biomarker that rises more specifically in bacterial infections than viral infections. It can help:

1. Guide initiation: Low PCT suggests viral infection, supporting withholding antibiotics.
   1. Guide discontinuation: Significant decrease in PCT (e.g., >80% from peak, or <0.25 or 0.5 ng/mL depending on assay) supports stopping antibiotics in lower respiratory tract infections and sepsis, even if fever persists. It’s a tool to supplement clinical judgment, not replace it.
2. What antibiotics are safe in pregnancy?

Antibiotics generally considered safe in pregnancy include: Penicillins (Amoxicillin, Ampicillin, Penicillin G), Cephalosporins (e.g., Cephalexin, Cefazolin, Ceftriaxone), Erythromycin (base or estolate preferred – avoid estolate in 1st trimester if alternatives exist), Azithromycin. Avoid: Tetracyclines (discolor teeth/bones), Fluoroquinolones (cartilage damage), Aminoglycosides (ototoxicity – use only if life-threatening), Sulfonamides (near delivery – kernicterus risk), Metronidazole (controversial in 1st trimester), Clarithromycin (theoretical risk). Dose adjustments needed as pregnancy increases renal clearance.

• How do I choose antibiotics for diabetic foot infections (DFI)?

DFI is often polymicrobial (Gram +, Gram -, Anaerobes). Mild/moderate infections: Oral Amoxicillin-Clavulanate or Clindamycin + Ciprofloxacin (if MRSA risk low). Severe infections: IV broad-spectrum (Piperacillin-Tazobactam, Ampicillin-Sulbactam, Carbapenem; add Vancomycin if MRSA risk). Crucially, antibiotics are adjunctive. Adequate surgical debridement and vascular assessment are paramount. Duration varies (1-2 weeks soft tissue, weeks-months for osteomyelitis).

• What is the recommended treatment for Clostridioides difficile infection (CDI)?

Initial episode: Fidaxomicin (200mg BD x 10d) is preferred over Vancomycin (125mg QID x 10d) due to lower recurrence rates. Metronidazole (500mg TID x 10d) is an alternative only if Fidaxomicin/Vanco unavailable. Severe/fulminant: Vancomycin 125mg QID PO plus Vancomycin 500mg PR QID plus IV Metronidazole 500mg TID. Recurrent CDI: Fidaxomicin or Vancomycin tapered/pulsed regimen or Fecal Microbiota Transplantation (FMT).

• When is surgical prophylaxis indicated?

Surgical prophylaxis is indicated for clean-contaminated, contaminated, or dirty procedures to prevent surgical site infection (SSI). It is generally not indicated for clean procedures without implants (e.g., breast biopsy, cataract surgery). Key principles: Use the right agent (target skin flora – Cefazolin first-line), right timing (within 60 mins before incision), right duration (single dose for most, redose if surgery >3-4h or major blood loss, never >24h).

• How should I dose antibiotics in obese patients?

Dosing in obesity is complex and drug-dependent. Some antibiotics use Total Body Weight (TBW – e.g., Vancomycin, Aminoglycosides), some use Adjusted Body Weight (AdjBW = IBW + 0.4*(TBW-IBW) – e.g., many Beta-lactams like Piperacillin-Tazobactam, Meropenem), and some use Ideal Body Weight (IBW). Consult specific dosing guidelines or pharmacy. Therapeutic drug monitoring (TDM) is essential for drugs like Vancomycin and Aminoglycosides.

• What are the first-line antibiotics for community-acquired pneumonia (CAP) in outpatients without comorbidities?

Amoxicillin (high dose, e.g., 1g TDS) OR Doxycycline OR a Macrolide (Clarithromycin or Azithromycin). Macrolide choice depends on local resistance rates; high resistance favors Amoxicillin or Doxycycline.

• How do I manage a patient with a beta-lactam allergy who needs treatment for syphilis? Penicillin is the only recommended treatment for syphilis. For non-pregnant patients with penicillin allergy: Doxycycline 100mg BD x 14 days (early syphilis) or 28 days (late syphilis) OR Tetracycline 500mg QID x 14/28 days. For pregnant patients or those with neurosyphilis/ocular syphilis and penicillin allergy: Penicillin desensitization is required followed by Penicillin therapy. Close monitoring is essential for non-penicillin regimens.
• What antibiotics cover Pseudomonas aeruginosa?

Anti-pseudomonal antibiotics include: Piperacillin-Tazobactam, Ceftazidime, Cefepime, Aztreonam, Meropenem, Imipenem-Cilastatin, Doripenem, Ciprofloxacin, Levofloxacin (higher doses), Aminoglycosides (Gentamicin, Tobramycin, Amikacin), Colistin/Polymyxin B. Use is guided by susceptibility testing and infection site. Often used in combination for serious infections.

• When is it appropriate to use combination antibiotic therapy?

Combination therapy is indicated for:

1. Empirical treatment of severe sepsis/shock (broad coverage until pathogen known).
   1. Infections with high risk of resistance (e.g., Pseudomonas, Enterococcus in specific settings).
   1. Synergistic effect (e.g., Ampicillin + Gentamicin for Enterococcal endocarditis; Beta-lactam + Aminoglycoside for Pseudomonas).
   1. Polymicrobial infections (e.g., intra-abdominal, diabetic foot).
   1. To prevent emergence of resistance (e.g., TB, some Gram-negatives). Avoid unnecessary combinations.
2. How do I choose antibiotics for acute exacerbations of COPD (AECOPD)?

Antibiotics are only indicated for moderate-severe exacerbations meeting Anthonisen Type 1 (increased dyspnea, sputum volume, sputum purulence) or Type 2 (2 of 3 symptoms). First-line: Amoxicillin-Clavulanate, Doxycycline, or TMP-SMX (if local resistance low). Reserve Fluoroquinolones (Levofloxacin, Moxifloxacin) for severe exacerbations, frequent exacerbations, or risk factors for resistant/Pseudomonal infection. Duration: 5-7 days.

• What is the treatment for bacterial vaginosis (BV)?

First-line: Oral Metronidazole 500mg BD x 7 days OR Intravaginal Metronidazole gel 0.75% once daily x 5 days OR Intravaginal Clindamycin cream 2% once daily x 7 days. Alternative: Oral Clindamycin 300mg BD x 7 days. Note: BV is not a classic “bacterial infection” requiring antibiotics in the same way as pneumonia; it’s an imbalance of vaginal flora. Treatment is for symptom relief and reducing complications (e.g., preterm birth, PID).

• How should I adjust antibiotic doses for patients on dialysis?

Dosing adjustments are complex and depend on the antibiotic, dialysis modality (hemodialysis vs. peritoneal dialysis), and dialysis schedule. Some antibiotics are removed by dialysis and require supplemental doses post-dialysis (e.g., Penicillins, Cephalosporins, Vancomycin – though timing varies). Others are not significantly removed (e.g., Ceftriaxone, Doxycycline). Consult detailed drug dialysis dosing references or pharmacy. TDM is essential when available.

• What is the role of intravenous-to-oral (IV-to-PO) switch therapy?

IV-to-PO switch is a key stewardship strategy to reduce cost, length of stay, and complications (e.g., line infections). Switch when: Patient is hemodynamically stable, improving clinically, able to tolerate oral intake/absorption, and has an oral antibiotic available with good bioavailability and appropriate spectrum. Common examples: Ceftriaxone to Cephalexin/Cefpodoxime; Levofloxacin IV to PO; Clindamycin IV to PO.

• How do I treat suspected bacterial meningitis?

Medical Emergency. Do not delay antibiotics for imaging/LP if suspected. Give empiric antibiotics immediately after blood cultures:

1. <1 month: Ampicillin + Cefotaxime (+ Acyclovir if HSV suspected)
   1. 1-23 months: Vancomycin + Ceftriaxone (+ Acyclovir)
   1. 23-50 years: Vancomycin + Ceftriaxone + Ampicillin (if Listeria risk)
   1. 50 years: Vancomycin + Ceftriaxone + Ampicillin Add Dexamethasone before or with first dose for suspected pneumococcal meningitis. Adjust based on Gram stain/culture. Duration typically 7-14 days.
2. What antibiotics are used for MRSA infections?

Options depend on infection severity and site:

1. Skin/Soft Tissue (Mild-Moderate): TMP-SMX, Doxycycline/Minocycline, Clindamycin (if susceptible).
   1. Skin/Soft Tissue (Severe/Systemic): IV Vancomycin, Linezolid, Daptomycin, Telavancin, Ceftaroline.
   1. Bacteremia/Endocarditis: IV Vancomycin or Daptomycin (check susceptibility).
   1. Pneumonia: IV Vancomycin, Linezolid, Telavancin, Ceftaroline.
   1. Bone/Joint: IV Vancomycin, Daptomycin, Linezolid; often followed by long-term oral suppression (e.g., TMP-SMX, Doxycycline, Clindamycin, Linezolid).
2. When should I use antifungal therapy alongside antibiotics?

Antifungal therapy is indicated when there is evidence or high suspicion of invasive fungal infection. This is not routine. Consider in:

1. Persistently febrile neutropenic patients despite broad-spectrum antibiotics.
   1. Patients with specific risk factors (e.g., prolonged ICU stay, broad-spectrum antibiotics, central venous catheters, TPN, abdominal surgery, colonization) and clinical/imaging findings suggestive of fungal infection.
   1. Proven fungal infection (e.g., candidemia, aspergillosis). Choice (Fluconazole, Echinocandin, Amphotericin B, Azole like Voriconazole/Posaconazole/Isavuconazole) depends on pathogen, site, and patient factors.
2. How do I manage antibiotic-associated diarrhea (AAD)?

Mild AAD: Often resolves with discontinuation of the offending antibiotic. Supportive care (hydration). Consider probiotics (e.g., Saccharomyces boulardii, certain Lactobacilli) may help prevent AAD, but evidence is mixed. Do not use anti-motility agents initially. If severe, persistent (>2 days after stopping antibiotic), or with warning signs (fever, bloody diarrhea, abdominal pain), test for C. difficile (toxin PCR/GDH/EIA). Treat CDI if positive (see Q14).

• What is the importance of an antibiogram?

An antibiogram is a report generated by a hospital or region’s microbiology lab summarizing the susceptibility patterns of common bacterial pathogens to various antibiotics. It is essential for:

1. Guiding empirical antibiotic choices for local infections.
   1. Tracking trends in antibiotic resistance over time.
   1. Informing antibiotic formulary decisions and stewardship interventions.
   1. Clinicians should be familiar with their local antibiogram.
2. What are the key principles of antimicrobial stewardship I should apply daily?
   1. Get Cultures: Before starting antibiotics when possible.
   1. Target Therapy: Treat only bacterial infections; avoid viral prescribing.
   1. Go Narrow: Use the narrowest spectrum effective antibiotic.
   1. Dose Right: Optimize dose, route, and duration based on patient factors.
   1. Review & De-escalate: Reassess at 48-72 hours; narrow spectrum or stop antibiotics based on clinical response and culture results.
   1. Switch to Oral: Convert from IV to oral when clinically appropriate.
   1. Know Local Resistance: Use your hospital/region’s antibiogram.
   1. Educate: Explain antibiotic use and importance of adherence to patients.
   1. Collaborate: Work with your antimicrobial stewardship program and pharmacy.

Medical Disclaimer:

The information provided on this website is for general educational and informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.