Antibiotic effectiveness isn’t just about which drug you use—it’s about where, when, how much, and how fast the dose is delivered.
For patients, such insights can spell the difference between a treatable infection and a tragic one.
For doctors, it can mean making the best of the medicines they have.
Since 2017, all U.S. hospitals receiving accreditation by the Joint Commission have been mandated to maintain antimicrobial stewardship programs (ASP).
An ASP is a coordinated effort to ensure that antibiotics and other antimicrobials are used appropriately to improve patient health, reduce antibiotic resistance, prevent infections, and lower costs.
The ASP at DHMC
The Dartmouth Health Medical Center (DHMC) has had a program since the 1990s and has become a leader in the field, investing in data-driven strategies to curb antibiotic misuse and combat resistance.
The ASP program helps care teams “prescribe the right antibiotics to the right patients at the right dose for the right amount of time,” says Rebecca Wang, MD, medical director of antimicrobial stewardship and assistant professor of medicine at Geisel.
How the program works
To help doctors choose the best antibiotics before lab results come back, Wang’s team uses something called a cumulative antibiogram—a yearly report that shows which antibiotics are most likely to work against the bacteria commonly seen at DHMC. Built from test results in a clinical microbiology lab, the antibiogram gives clinicians a local, up-to-date snapshot of resistance trends. This snapshot helps guide treatment decisions when a patient first comes in, even before more specific test results are available.
Once those results do arrive, Wang and her infectious disease pharmacists collaborate with frontline clinicians throughout DHMC to fine-tune treatment plans, again using susceptibility test results from the clinical laboratory. Sometimes, her team recommends narrower-spectrum antibiotics that she says are “just as effective but carry fewer side effects and contribute less to future antibiotic resistance—not only for the individual patient but also for the institution and [public health] more broadly.”
Sometimes, a different approach is taken.
“If a patient is immunocompromised or has a history of infections with resistant organisms, for example, we’ll consult with their oncologists or care providers to consider the nuances and arrive at a treatment decision,” Wang says.
“It’s always a dialogue about how to balance the likelihood of effectiveness with stewardship.”
Find out more
To learn more about how we monitor antibiotic treatment and why it matters, read "Battling the Antibiotic Apocalypse: How Dartmouth researchers and doctors are leading the fight against antibiotic-resistant infections" in Vitals Magazine, a publication of Dartmouth Health and Geisel School of Medicine.