Seeking relief

Call to action: 5 ways DOs can practice antimicrobial stewardship

JAOA studies find the osteopathic approach to medicine could be the key to fighting antibiotic misuse.


Once considered a revolutionary tool in fighting infectious diseases, antimicrobials and their effectiveness have been called into question as drug-resistant bugs become more commonplace. Recently, The Journal of the American Osteopathic Association (JAOA) focused on ways to combat the overuse of antibiotics and the potential of using osteopathic manipulative treatment (OMT) as an agent in antimicrobial stewardship.

Conduct research

“Osteopathic physicians have an opportunity to improve antimicrobial use in primary care by conducting original research and gathering evidence on how OMT may enhance or preclude the need for antimicrobials,” wrote Robert Orenstein, the AOA editor-in-chief, in an editorial.

Here are four other ways DOs can practice antimicrobial stewardship.


An analysis of a multicenter randomized controlled trial found that patients aged 50 or older with pneumonia could have a reduced hospital stay when treated with OMT.

In the study, researchers examined data from patients who were randomly assigned to three groups and received OMT, light touch or conventional care only. The per-protocol analysis, which examined only the participants who finished the study without missing any treatments, found the OMT group had a decreased hospital stay by 1.1 days compared to those who received conventional care only.

Prescribe antibiotics responsibly

About 1 in 3 antibiotic prescriptions are unnecessary, according to findings from the Centers for Disease Control and Prevention (CDC). Of those prescriptions, CDC researchers found most were for respiratory conditions caused by viruses that do not respond to antibiotics.

In his editorial, Dr. Orenstein notes that studies have uncovered strategies that may help reduce unnecessary antibiotic use, including delaying prescriptions when patients request antibiotics to treat a cold.

Establish an antimicrobial stewardship team

Researchers at two academic medical centers found that recommendations from interprofessional antimicrobial stewardship programs (ASP) were more likely to be accepted by the primary medical and surgical teams at two academic medical centers.

In the study, during face-to-face conversations, the ASP teams discussed patients’ conditions and recommendations to reduce inappropriate use of antimicrobials with the primary medical and surgical teams. The study found more than 90% of the interventions were accepted by the treating physicians.

“Osteopathic physicians can use these lessons to model programs at their community-based hospitals,” Dr. Orenstein wrote in his editorial.

Partner with your patients

Physicians can go back to the basics of osteopathic medicine by educating their patients on prevention strategies such as frequent hand washing to help avoid bacterial infections and the need to take antibiotics.

“Preventing infectious diseases, enhancing patients’ immune systems, working in interdisciplinary teams, and using OMT to improve our patients’ health are all foundations of osteopathic medicine,” Dr. Orenstein noted in his editorial.

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