Recently, I gave a talk on antibiotics to a small group of medical students and residents. After discussing common bacterial pathogens and the antimicrobial agents that target them, we turned to our list of inpatients on the ID service for review of their antibiotic histories. Each patient had been given more than a handful of different antibiotics since arrival, but the students and residents were unsure of why the empirical antibiotics were chosen in the ED, whether antibiotics deserved to be changed because of new data or exam findings, or what side effects and toxicities needed to be considered.
I was quickly reminded of how casually antibiotics can be ordered and administered, even when unnecessary or inappropriate. I realize that microbiology and pharmacology are hard topics — after all, infectious disease physicians like myself spend our entire careers studying the relationship between the two so that we can make expert clinical judgements. That being said, any physician who identifies infection and orders antibiotics should be knowledgeable about common pathogens and competent in choosing appropriate treatments.
Yet, I think antibiotics are often prescribed with limited consideration of a patient's differential diagnosis, potential causative microbiology, appropriateness of treatment and duration, possible side effects, or long-term consequences.
