Deconstructing Long-Held Antibiotic Prescribing Myths

Long-held prescribing practices can be handed down from generation to generation. Instructors provide their learners with the information they believe to be true. These can become best practices or pearls for clinicians to follow even if the science and the literature has evolved to reflect updated thinking on therapies.

“This comes from a lot of ID being folklore, quite honestly,” said Erin K. McCreary, PharmD, BCPS, BCIDP, director of Infectious Diseases Improvement and Clinical Research Innovation, UPMC, and clinical assistant professor of Medicine, University of Pittsburgh. “Say you get taught something, and you get taught it by someone you respect and you value. You never ask, ‘Oh, what's the reference for that?’”

However, these long-held beliefs can be counterproductive. A new study in the IDSA journal, Clinical Infectious Diseases, examines antibiotic myths that have been handed down to learners for years.

McCreary was the first author on this paper, and she believes it is important to be open to challenging traditionally held prescribing practices and tries to bring a sense of humility to the table when students ask her questions on topics not definitively known. “The most important thing I do is say, ‘I'm wrong every day,’ or tell my learners, ‘Hey, I have no idea of the answer to the really great question you just asked me—let's look it up and learn together…’Honestly, you learn more because it builds a culture of trust and humility and openness to filling those gaps.”

The inspiration for the paper came from a Twitter discussion in the #IDTwitter group when Jason C. Gallagher, PharmD, FCCP, FIDP, FIDSA, BCPS, queried people on the social media platform around antibiotic myths that were commonplace and what was being taught as a matter of fact without any one definitive paper or literature confirming it.

McCreary reached out to Gallagher and they began compiling myths with the help from others. Although the myths they covered were around older antibiotics, McCreary says it was not done intentionally and the myths they chose for the paper had been studied at length in the literature.

One of the myths she found most interesting was that cefazolin should be avoided for central nervous system (CNS) infections. “Because I think getting into the history of CSF concentrations as a surrogate for CSF penetration, or does it get to the brain is really fascinating,” McCreary said.

Contagion spoke to McCreary on some of these long-held myths, and the importance of keeping an open mind around long-held beliefs on therapies, especially if there is newer, contradictory data or information on them.