Rachel Bartash, MD

As much as 50% of all antibiotic prescriptions are considered “inappropriate.” While there is no consensus definition, experts consider antibiotics to be “inappropriate” when they are prescribed for nonbacterial infections, the spectrum of coverage is overly broad and potentially toxic, the dose is inaccurate for the host, or the intended duration is too long. “Inappropriateness” contributes directly to medication side effects, interactions, kidney and liver dysfunction, Clostridium difficile infections, and the emergence of multidrug-resistant pathogens. As early as 1945, Sir Alexander Fleming, the pioneer of the antibiotic era, warned that the overuse of antibiotics “clearly drives the evolution of resistance,” but only recently has antibiotic resistance risen to the forefront of scientific and political agendas.