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Antimicrobial Resistance 2019

Stewardship programs improve patient outcomes

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Dr Thomas File, Jr, FIDSA

President, Infectious Diseases Society of America

As an infectious diseases physician, I have come to dread seeing a patient’s condition worsen – and even become life-threatening – due to an infection that would have once been simple to treat.


Unfortunately, the rising tide of antibiotic resistance, coupled with insufficient research and development of new antibiotics, is making this devastating scenario more frequent. Not only does this mean that once easily treatable infections can now be fatal, but many of the life-saving medical advances that we’ve come to take for granted — cancer chemotherapy, organ and bone marrow transplants, joint replacements and other surgeries — may become impossible to perform safely. These procedures increase infection risk but have been made safe by antibiotics. Now we are seeing increasing numbers of patients who can beat cancer or successfully receive a new kidney, liver, hip or knee, only to die from an infection that is resistant to antibiotics.

How did we get here? And, perhaps more importantly, how can we ensure that we do not lose antibiotics—and the medical advances they enable—entirely? The solution is complex, but attainable and necessary.

Appropriate use of antibiotics

Overuse and misuse of antibiotics drives the development of antibiotic resistance. This means that the more we use antibiotics, the less effective they become over time. We need coordinated interventions in hospitals, doctors’ offices and other healthcare settings to ensure that antibiotics are used appropriately. Infectious diseases physicians lead antibiotic stewardship programmes—efforts whose very purpose is to promote optimal antibiotic use.

Ample data demonstrates that stewardship programmes reduce inappropriate antibiotic use and improve patient outcomes — meaning that patients are cured and released from the hospital more quickly and are less likely to suffer from negative side effects associated with inappropriate antibiotic use. The federal government needs to invest in stewardship programmes and in the expert workforce needed to make them work.

Action needed from policymakers

Stewardship alone will not solve this problem. Even necessary and appropriate antibiotic use will cause resistance to develop, albeit at a slower rate. We need to invest in the discovery and development of new antibiotics.

The pharmaceutical industry has largely abandoned antibiotics because these drugs are not profitable. Typically taken for a short duration and held in reserve to protect their usefulness, antibiotics do not yield a quick return on the investment required to develop them. The federal government must step in to ensure that the antibiotic market does not collapse, reversing decades of medical progress and leaving physicians and patients without these life-saving medicines.

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