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Antimicrobial Stewardship: Stemming the Tide of Antibiotic Resistance

Antimicrobials have changed the way bacterial illnesses are treated and have had a profound effect on the health and wellness of people worldwide. Prontosil, the first commercially available antibacterial, was developed by German bacteriologist and pathologist Gerhard Domagk in the 1930s. By the 1940s, penicillin was being widely used and we saw rates of deaths from illnesses such as strep throat plummet.

Decades later, antibiotic resistance is now an urgent threat to public health worldwide. A growing number of serious infections, such as tuberculosis, pneumonia, gonorrhea, and salmonellosis, have become harder to manage as the antibiotics used to treat them lose their effectiveness.

The consequences are staggering. Each year in the United States at least:

Antibiotic misuse is accelerating the process of resistance. Commonly used antibiotics have become less efficacious, adding a layer of complexity and risk to organ transplantation and chemotherapy treatment and even common surgical procedures. Antibiotic resistance leads to longer hospital stays, higher medical costs, and increased mortality.

What Can We Do?

The goal of antibiotic stewardship is to treat patient infections while minimizing the risks of antibiotic resistance and adverse side effects. An antibiotic stewardship strategy includes reducing the spread of bacteria in health care settings, educating patients on antibiotic use, and following clinical guidelines on whether to prescribe antibiotics and on prescribing the right antibiotic at the right dose for the right duration.

As health care providers we can encourage and remind our patients to:

  • Complete the entire course of antibiotics, even after they feel better.
  • Properly dispose of any leftover medication; never share it with others.
  • Never self-medicate by taking leftover medication or taking antibiotics originally prescribed to another person.

Patient education is an important cornerstone of antimicrobial stewardship strategy, but it is only one part of the equation.

Reducing Improper Antibiotic Prescribing by Improving Diagnosis

Getting the diagnosis correct is another key step in the fight against antibiotic resistance. Three diagnoses frequently misdiagnosed in patients and subsequently treated with unnecessary antibiotics are:

  • urinary tract infections
  • upper respiratory infections
  • cellulitis

Reducing the over-prescription of antimicrobials begins at the point of care. Below are some tips to make more accurate and informed decision making at the point of care for those frequently misdiagnosed conditions.

Urinary tract infections: These are commonly treated with antibiotics, but research suggests that this is over-diagnosed, especially among women and the elderly. An estimated 40% of patients treated with antibiotics for a presumptive diagnosis of UTI are treated so unnecessarily. Other potential diagnoses, including sexually transmitted infections, should be carefully considered. 

erythemanodosum.jpgCellulitis: Cognitive mistakes, such as premature closure, lead to the “red leg” being consistently over-diagnosed as cellulitis. Unnecessary antibiotic treatment puts patients at an increased risk for hospital-acquired infections such as Clostridium difficile, medication reactions, and other adverse events. VisualDx can teach clinicians how cellulitis presents and how to rule out stasis dermatitis, a frequent cause of bilateral leg redness.

Upper respiratory tract infections: We know it can be challenging to differentiate acute bacterial sinusitis from viral sinusitis, especially within the first few days. Watchful waiting is recommended.

Antimicrobial Stewardship

We can provide better care to our patients, improve outcomes, and reduce costs if we correctly identify the diagnosis at the point of care. Health information technology can improve clinical decisions and reduce error. By focusing on educating patients and adhering to proper prescribing guidelines, we can all do our part to minimize risk of antibiotic resistance and its adverse side effects.

VisualDx is committed to supporting health care professionals in this important effort. Click here to download more information or contact to see how you can add clinical decision support resources into your antimicrobial stewardship program.

For even more public health resources, click here

About VisualDx

VisualDx is an award-winning diagnostic clinical decision support system that has become the standard electronic resource at more than half of U.S. medical schools and more than 1,500 hospitals and institutions nationwide.  VisualDx combines clinical search with the world's best medical image library, plus medical knowledge from experts to help with diagnosis, treatment, self-education, and patient communication. Expanding to provide diagnostic decision support across General Medicine, the new VisualDx brings increased speed and accuracy to the art of diagnosis. Learn more at