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Skip to 0 minutes and 7 secondsAs an infectious disease physician, I prescribe antibiotics on a daily basis. And although there are antibiotic guidelines at a hospital that antibiotics should be used for certain indications, the choice of therapy is often difficult. First, you have to determine the likelihood of the patient being infected at all. Then you have to distinguish bacterial infection from viral and other infections that shouldn't be treated with antibiotics at all. In most cases, this can be assessed based on the history of symptoms and clinical examinations. Blood samples, x-rays, CT scans, and other investigations are, at this stage, helpful to diagnose the infection site and probable pathogen. However, none of these tests can for sure determine whether a patient has a bacterial infection or not.

Skip to 1 minute and 5 secondsCultures of blood, urine, and other samples are needed to identify the bacteria and their susceptibility to certain antibiotics. And this takes at least one or two days. This means that, in most cases, the choice of antibiotic therapy is made in a situation, where we don't know for sure what kind of infection the patient is suffering from, if antibiotics are needed at all, and what drugs are effective. When treating a mild infection, for example, a lower urinary tract infection, a narrow-spectrum antibiotic are typically used. For these patients, an ineffective treatment may result in prolonged symptoms, but basically, no risk for severe consequences or death.

Skip to 2 minutes and 3 secondsOn the other hand, when treating a patient suffering from septic shock, every hour of delayed treatment may result in higher mortality rates. Therefore, broad-spectrum antibiotics are prescribed for these patients. The difficult part is that you don't know in advance the natural dynamics of the infection and what patients that will get worse the following day. Then you also have to consider risk factors for bacterial resistance. Previous colonisation or infection with resistant strains, hospitalisation, multiple chronic diseases, and recent antibiotic therapy are all known risk factors for bacterial resistance. Also, international travel to high prevalence areas increases the risk for resistant, gram-negative bacteria.

Skip to 3 minutes and 3 secondsIn the end, you have to make a risk assessment based on a number of patient-specific factors, which is always complex. Of course, we try to avoid unnecessary prescription and to use narrow-spectrum antibiotics, when possible, to reduce side effects and resistance development.

Skip to 3 minutes and 30 secondsIn a way, this is also an ethical dilemma. What risks can we tolerate for our patients today, in order to preserve effective treatment for future patients?

A doctor's reality

Watch Dr Hanna Montelin talk about the challenges in clinical practice she faces in her daily work at the hospital.

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This video is from the free online course:

Antibiotic Resistance: the Silent Tsunami

Uppsala University

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