The Lean Antibiotic Mantra

Sometimes Nothing Is Better Than Something

Neil Gaffin, MD; Brad Spellberg, MD

Disclosures

April 09, 2018

This is another example of how combining key elements from the history and clinical exam (afebrile, wheezing, normal WBC count) create a low clinical pretest probability for a bacterial pneumonia in the setting of an abnormal chest x-ray. Coupled with identification of a viral pathogen and a low procalcitonin level, the likelihood of an invasive bacterial coinfection is very low, safely supporting a decision not to administer further antibiotics. This patient continued to improve with supportive care.

These cases are representative of scenarios that occur thousands of times daily in this country. It's critical that we challenge not only the need for the daily continuation of antibiotics for a given diagnosis, but also the diagnosis itself. All of these patients' continued to improve after cessation of antibiotic therapy.

It's critical that we challenge not only the need for the daily continuation of antibiotics for a given diagnosis, but also the diagnosis itself.

Antibiotics are a shared societal trust—use in one individual affects subsequent use in others. If the initial diagnoses in these cases were not challenged, the combined net effect would have been individual and societal exposure to many days of unnecessary therapy. With a looming post antibiotic era and the ever-present threat of Clostridium difficile infection, it is incumbent upon all of us to do what we can to preserve the miracle of antibiotics and minimize concomitant harm.

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