Juang and Micek Receive Grant from Merck and Co.

Published on 25 May 2021

Antibiotic resistance is a mounting concern in the health care community, especially as bacterial infections, such as pneumonia and blood stream infections, grow increasingly more resistant to antibiotic treatment.

As pharmacists who work primarily in the intensive care unit (ICU) at Barnes-Jewish Hospital, Paul Juang, Pharm.D., FASHP, FCCM, BCPS, BCCCP, professor of pharmacy practice at University of Health Sciences and Pharmacy in St. Louis, and Scott Micek, Pharm.D., FCCP, BCPS, professor of pharmacy practice and director of the Center for Health Outcomes Research and Education at UHSP, saw an opportunity to dig deeper into the financial implications of empirically using traditional broad spectrum antibiotics to treat patients in the ICU versus newer, broad spectrum antibiotics that have enhanced activity against multidrug-resistant bacterial pathogens. 

The growing resistance of infections to antibiotics has spurred the development of newer, more broad spectrum antibiotics that provide more coverage and therefore a higher likelihood of effective treatment, but the financial implications associated with a newer and broader spectrum antibiotic are something hospitals and treatment centers have to take into consideration when it comes to treatment plans.

"Many factors go into the decision-making process of empiric antibiotic selection for critically ill patients," Micek said. "The goal for each patient is to choose a regimen that has activity against all potential pathogens, including those harbingers of antibiotic resistance. Fortunately, there are many more antibiotic options to choose from given the increasing prevalence of antibiotic resistant pathogens that we routinely encounter."

After receiving approval on an investigator initiated grant in January from Merck & Co., Juang and Micek have been collecting and analyzing data to compare the financial impacts of first treating patients with older broad spectrum antibiotics before encountering resistance and then prescribing more broad spectrum antibiotics versus the financial impacts of treating a patient with a newer, more broad spectrum antibiotic from the onset.

"We are most interested in whether there is a difference in cost and if there is a difference in patient outcomes, when it comes to treating patients with more resistant infections," Juang said. "Often we use the older and less broad spectrum antibiotics, only to realize that the patients have developed resistance to those antibiotics. Not every patient who comes in encounters this, but it does happen."

There is great potential that the findings of Juang and Micek could impact future treatment approaches for patients with a high number of risk factors for resistant infections, and in turn, uncover a more effective and efficient patient care approach.

Juang and Micek will conduct the study through January 2022 with the intention of presenting their findings at the Society of Critical Care Medicine's annual Critical Care Congress.

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