Path of Least Resistance

Antimicrobial stewardship: Undoing overuse of antibiotics

AOA Editor-in-Chief Robert Orenstein, DO, attends White House forum aimed at decreasing antibiotic resistance.


In the 20th century, the miracle drugs of antimicrobials revolutionized the care of patients with previously fatal infectious diseases. The ability to prevent and control infections through the wise use of these agents led to major advances in surgery, oncology, immunology and transplantation. Over the past several decades, however, microbes resistant to many of these agents have emerged—to the point that some healthcare institutions regularly see infections
resistant to all the currently available antibiotics.

Robert Orenstein, DO

Today, more than 250 million outpatient antibiotic prescriptions are written, but nearly half of those are for inappropriate indications. Antibiotics have been used too indiscriminately for too long, and the window of opportunity to reduce this misuse is narrowing.

On June 2, 2015, I attended the White House Forum on Antibiotic Stewardship as a representative of the AOA. The forum engaged stakeholders, including leaders of healthcare institutions, professional organizations, agribusiness and industry, in improving the use of antimicrobials in human and animal health. Federal regulations were announced against human antibiotics in food and the movement away from antibiotic use for promoting animal growth, and increased funding is planned to combat antimicrobial resistance. Numerous stakeholders and the US federal government have committed to this public safety and biosecurity issue. In fact, hospitals will soon be mandated to have antimicrobial stewardship programs.

Effective mechanisms to improve antimicrobial use in ambulatory care presents a golden opportunity for the osteopathic medical profession, which focuses on delivering comprehensive primary care. The development of traditional and novel tools to fill educational gaps among medical trainees and physicians is an opportunity for AOA communications.

Thus, as part of the commitment to this effort, the AOA will leverage its ability to communicate with its members and patients and to engage leadership and policy makers in the effort to improve antimicrobial use. The Journal of the American Osteopathic Association (JAOA), for example, will be introducing a series of briefs, original articles and reviews that address antimicrobial stewardship. Original research and evidence on how osteopathic manipulative treatment may enhance or preclude the need for antimicrobials would be valuable contributions to the public’s health. Regular briefs of key advances in antimicrobial use will keep the osteopathic community informed and present an opportunity to improve patient safety. We will be initiating the series with a call for papers, as well as outreach to our schools, training programs and experts in the field. Those interested in contributing to the series are invited to contact the JAOA at

Leave a comment Please see our comment policy