By David Banach of Woodbridge
In the wake of the COVID-19 pandemic, our healthcare systems have learned many valuable lessons about infection prevention and response. But even as we continue to address the challenges brought on by the virus, we cannot afford to ignore another long-standing and growing public health threat: antibiotic resistance.
Antibiotics are life-saving drugs. They’ve transformed modern medicine, making it possible to treat once-deadly infections, perform surgeries safely, and care for vulnerable patients. But overuse and misuse of these medications are rapidly diminishing their effectiveness. As bacteria adapt and become resistant, we are seeing infections that are harder—and sometimes impossible—to treat.
That’s where antibiotic stewardship comes in. As a physician and infection prevention leader, I’ve seen how thoughtful, evidence-based prescribing can slow resistance and protect patients from antibiotic-associated adverse events. In a post-pandemic world, where the threat of drug-resistant infections continues to rise, smart prescribing must remain a central pillar of infection prevention.
The Hidden Impact of the Pandemic on Antibiotic Use
During the height of the pandemic, hospitals and clinics were overwhelmed. In the early stages, when little was known about COVID-19, many patients were prescribed antibiotics “just in case.” This wasn’t done out of carelessness—it was a reflection of the uncertainty we all faced. But the unintended result was an uptick in unnecessary antibiotic use, even though COVID-19 is caused by a virus, not a bacteria.
At the same time, infection prevention measures like masking, distancing, and hand hygiene likely led to fewer viral and bacterial infections in some settings. Now that many of those measures have relaxed, and healthcare delivery has returned to more normal patterns, we’re seeing antibiotic use rise again. This is a crucial moment to re-emphasize stewardship principles and prevent the backsliding of hard-won progress.
Why Smart Prescribing Matters
Antibiotic stewardship isn’t just about reducing prescriptions—it’s about making sure antibiotics are used when they are truly needed, and used in the right way. That means:
- Prescribing only when there is a clear bacterial infection.
- Choosing the right antibiotic based on the specific infection and likely organisms.
- Using the correct dose and duration—no more, no less.
When antibiotics are overused, bacteria learn to survive and spread. These resistant strains can cause infections that are more difficult to treat, lead to longer hospital stays, increase healthcare costs, and, in some cases, result in death.
Patients and providers alike must understand that antibiotics are not harmless or automatic. They are powerful tools that should be used carefully—because when they no longer work, everyone is at risk.
The Role of Healthcare Providers in Stewardship
Physicians, nurse practitioners, physician assistants, and pharmacists all have an essential role in antibiotic stewardship. As clinicians, we are responsible for making informed decisions, educating our patients, and modeling best practices.
In hospital settings, stewardship teams review antibiotic use, monitor resistance patterns, and support frontline providers in making evidence-based choices. In outpatient clinics, we have an opportunity to guide patients away from expecting antibiotics for viral illnesses like colds and the flu.
As someone involved in infection prevention, I’ve seen how a culture of stewardship—where careful prescribing is seen as a shared responsibility—leads to better outcomes. When providers feel supported and informed, they are more likely to follow guidelines and question routine or habitual prescribing.
Educating Patients and the Public
Public expectations play a large role in antibiotic use. Many people still believe that antibiotics will help with a sore throat, cough, or runny nose—even when these symptoms are likely caused by viruses. Others may pressure providers for prescriptions, believing it will speed up recovery or prevent complications.
This is where patient education becomes so important. We must take the time to explain why an antibiotic isn’t needed, what to expect from the illness, and how to manage symptoms safely. Clear, respectful communication builds trust—and often, patients appreciate knowing their provider is acting in their best interest.
Public health campaigns also play a role in shifting perceptions. Messaging that emphasizes the dangers of resistance, while empowering people to ask questions about their care, can help reduce unnecessary demand for antibiotics.
Integrating Stewardship Into Daily Practice
Smart prescribing shouldn’t be an afterthought—it should be built into daily clinical workflows. That includes:
- Using clinical decision support tools to guide antibiotic choices based on current guidelines.
- Reviewing prescriptions regularly, especially in hospitals, to ensure ongoing need.
- Tracking and reporting antibiotic use to identify trends and areas for improvement.
- Collaborating with infection prevention and pharmacy teams to align goals.
Medical education must also prioritize stewardship. Training students and residents to think critically about antibiotic use prepares them to be better clinicians and stewards from the very beginning of their careers.
Looking Ahead: Stewardship as a Long-Term Strategy
Antibiotic resistance won’t go away overnight. It will require ongoing commitment from healthcare systems, providers, policymakers, and the public. Stewardship programs must be supported with resources, leadership, and clear metrics for success.
We also need innovation—new diagnostics to quickly identify bacterial infections, new antibiotics to treat resistant organisms, and new strategies for preventing infections in the first place. But no matter how much we innovate, the foundation remains the same: use antibiotics wisely.
Prevention Begins With Prescribing
Infection prevention doesn’t start in the lab or the ICU—it often begins with the simple decision of whether to prescribe an antibiotic. As healthcare providers, we must recognize the power of that moment and the responsibility it carries.
In a post-pandemic world, where resilience and preparedness are more important than ever, antibiotic stewardship is a critical part of our defense against the next wave of infectious threats. By staying vigilant, thoughtful, and committed to smart prescribing, we protect not only our patients today—but the generations to come.