CEimpact Podcast

How OTC Pain Medications May Fuel Antibiotic Resistance

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Pain relief medications like acetaminophen and ibuprofen are staples in everyday care—but emerging research suggests they may play a role in antibiotic resistance. This episode reviews recent findings, explores how these common drugs may influence bacterial response to antibiotics, and highlights pharmacist‑specific considerations. You will walk away with practical insights to support informed medication use and strengthen antibiotic stewardship.

HOST
Rachel Maynard, PharmD
GameChangers Podcast Host and Clinical Editor, CEimpact
Lead Editor, Pyrls

Hunter O. Rondeau, PharmD, BCIDP, AAHIVP
Antimicrobial Stewardship Coordinator, SSM Health
Adjunct Clinical Assistant Professor, University of Kansas School of Pharmacy

Rachel Maynard has no relevant financial relationships with ineligible companies to disclose. 

Hunter Rondeau is a consultant for Pyrls, a speaker for ASHP, and was a speaker for ACCP (ended October 2025) and Vituity (ended May 2025). All relevant financial relationships have been mitigated.
 
CPE REDEMPTION
This course is accredited for continuing pharmacy education! Click the link below that applies to you to take the exam and evaluation:


CPE INFORMATION
Learning Objectives
Upon successful completion of this knowledge-based activity, participants should be able to:
1. Describe emerging evidence on how common OTC pain medications may influence antibiotic resistance.
2. Identify pharmacist strategies to optimize analgesic and antibiotic use while supporting antimicrobial stewardship.

0.05 CEU/0.5 Hr
UAN: 0107-0000-25-372-H01-P
Initial release date: 12/8/2025
Expiration date: 12/8/2026
Additional CPE details can be found here.

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SPEAKER_00:

Here on Game Changers, we're all about helping you stay ahead of pharmacy practice. But why stop at listening? You can earn CE credit for this episode and hundreds more by visiting CEimpact.com and logging into your account or creating a new one. Get credit, get inspired, and make your learning count. Hey CE Impact subscribers, and welcome to the Game Changers Clinical Conversations Podcast. I'm your host, Rachel Maynard, and I'm super excited about our discussion today. Now, recently there have been some headlines popping up in the lay press. Some examples include things like common painkillers, ibuprofen, and acetaminophen found to fuel antibiotic resistance. And study warns that common painkillers may fuel deadly superbugs that resist antibiotics. And so I think that's something that's likely to get our patients' attention and start raising questions. And it also raises questions for us as pharmacists, I think, because I don't know that we'd necessarily think that these OTC analgesics, which are so commonly used, would play a role in antibiotic resistance. So to help us put those headlines in perspective, I am very excited to have Dr. Hunter Rondo with us today. So welcome, Hunter.

SPEAKER_01:

Hello, thanks for having me. I'm I'm as excited as you are about this topic because as soon as this thing came out, my ID physicians were like, okay, what's your hot take?

SPEAKER_00:

Well, we're gonna get the hot take from you then. I'm very excited to get that. And I know, Hunter, you've been on the podcast before. And you and I have worked together at Pearls, which is a drug information resource and modern platform with pharmacotherapy resources. So super excited to have your expertise here. And maybe you can just share a little bit about your background outside of Pearls and also, you know, your role currently and maybe why you're interested in this topic. You you sort of gave a little sneak preview to that with uh the fact that you were already getting questions about this, but let's hear a little bit about yourself.

SPEAKER_01:

Certainly. So I'm a regional antimicrobial stewardship coordinator at SSM Health in St. Louis, Missouri. So I'm part of a whole system team of infectious disease pharmacists, infectious disease physicians, infection preventionists, where I serve as not only a liaison to the system, but also I support some of the ministries. I think what was it? We're at 23 ministries across the health system. Um I have three that I primarily take care of. So in addition to that, I also have a couple adjunct faculty appointments, both at the University of Kansas School of Pharmacy, which is my alma mater, Goach Ahawks, as well as since now I'm in St. Louis, I was like, I should probably also be connected with the local college of pharmacy. So I also have an adjunct appointment at the uh St. Louis College of Pharmacy, but it's now a UHSP. So I have a ton of trainees too. So I'm very prepared for these kind of inquisitive questions that come up.

SPEAKER_00:

Excellent. And it's interesting to me that you, your, you and your colleagues were hearing about this also in the lay press. So this was something that you know patients are very likely to hear about also, and especially as we head into sort of this cough and cold season and the antibiotic use becoming more common, perhaps, and also the need for analgesics over the counter becoming more common. This question is likely to come up. So super excited to have you. Thank you so much for your time and joining us today. Maybe we can just get started with you know, getting on the same page about what is antibiotic, antimicrobial resistance and why is it something we need to be concerned about.

SPEAKER_01:

Certainly. So to start with, antibiotic resistance is while we look at it when it comes to clinical outcomes as this makes it more difficult to use some of the newer or even older antimicrobials. Uh, when I think about antibiotic resistance, that happens whether the antibiotic is used appropriately or inappropriately. So that's something like, oh, it's not all of this inappropriate antibiotic use causing resistance. Like the bacteria doesn't know if the person who chose to use the antibiotic had put a lot of thought into their decision making behind it. So it is it's an unavoidable event associated with using antibiotics. So it's we live in a world that we are sharing it with these bacteria, and so we don't there are ways that we can help minimize antibiotic resistance, with with the main thing being that that selective pressure of okay, if I'm not using antibiotics, the bacteria don't have a reason to put up defenses to prevent those antibiotics from affecting them.

SPEAKER_00:

So the only way to fully prevent the risk of antibiotic resistance would be to not use antibiotics, period.

SPEAKER_01:

That's pretty much the main thing that I stress is if you're truly worried about antibiotic resistance, the key thing you should think about is judiciousness with antibiotics.

SPEAKER_00:

Because we need to use them.

SPEAKER_01:

Exactly. Yeah. And that and that's the main thing I want I want to stress with antibiotic resistance is it's gonna happen. It's unavoidable. It's one of those, it's just gonna happen. But when you think about the different, you know, medical innovations that have came about in the last hundred years, the advent of antibiotics has completely like changed our like our lifespan, clinical outcomes. So like using antibiotics is is great whenever we are judicious about it, and it has a clear evidence-based indication. But using them inappropriately, then oh, good, you're fine.

SPEAKER_00:

No, no, but using them inappropriately, finish that thought.

SPEAKER_01:

Yes. So using them appropriately, yes, we know that there's all these benefits with it, but then when we get into these areas of unclear benefit or just in case prescribing, or or you get into these situations where there's an unclear benefit, so the decision to give antibiotics occurs, well, there's there's harms associated with antibiotic use, whether it's appropriate or not. And one of those harms is antibiotic resistance.

SPEAKER_00:

Yep. Okay. And just thinking about the fact that antimicrobial resistance does seem to be in the news generally lately. Is there anything sort of spurring this more than in the last couple of decades, or any reason why we're hearing more about this now than before?

SPEAKER_01:

Uh it seems like every year there's some different large group that publishes some more data about, you know, based on the current track that we're going, we're going to see more patients die of antibiotic-resistant infections, or we're going to see less first-line antibiotics be effective for different infections. I think the biggest one that really was circulating on TikTok recently was the CDC released a report talking about the nightmare bacteria running around. And I had a lot of people ask me, they're like, What's this nightmare bacteria? I'm like, Oh, this is a nightmare. Astinitobacter is absolutely terrible.

SPEAKER_00:

Okay. Okay.

SPEAKER_01:

And it's it makes it a lot of fun to go. I do this thing called handshake stewardship where I physically go to the floors and talk with the nurses, talk with the physicians in the in the hospital. And one of the things that comes up is when I see these really scary bacteria, we'll often do what's called isolation on these patients. And I'll go, this patient has two antibiotics left. So if you weren't washing your hands before, be washing your hands now. And it was very, it was actually very helpful whenever that TikTok was circulating about the nightmare bacteria. I'm like, that's what's in there. Yeah. And so it helped, it helps people see, like, oh, okay, that thing that I'm seeing on social media or that I'm seeing in the different news outlets, like, that's not this distant, this thing that's really distant from me. Like, this is happening right in front of me.

SPEAKER_00:

Mm-hmm. Mm-hmm. Yeah, it really crystallizes it to have a specific patient associated with that risk. Yeah, that that's a great example. And I guess what are sort of you talk uh your practice is inpatient, and so what factors do you see most commonly or do you think of most commonly in terms of increasing the risk of antimicrobial resistance outside of that inappropriate antibiotic use? Are there patient-specific factors that are an issue?

SPEAKER_01:

Yeah, there are two main ones I'll stress. And I know I stressed this one before, but I'll say it again because it's worth it, it's worth stressing, and that's antibiotic allergies. This comes up all the time. They're like, this penicillin allergy, it's not that bad that it's on their chart. Just type in penicillin allergy clinical outcomes, and you will be shocked at how devastating it can be to someone of having a penicillin allergy. Um, there's actually a really good podcast, Freakonomics. I love listening to them, where they had Dr. Kimberly Blumenthal, who's a well-respected immunologist who talks about penicillin allergies, and it translates it into a less, a less of a clinician-focused and more of like a patient-friendly conversation about just how bad penicillin allergies are. So I won't rehash that episode, but it's the freaking omics episode about like, oh, you're probably not penicillin allergic. But man, every time I do a topic discussion with my trainees about antibiotic allergies, and since 10% of the population in the US have a penicillin allergy, I usually get one or two trainees a year that have an allergy and they're so terrified afterwards, they're like, How do I get this off? How do we do a challenge and get this stopped? But the back to the point, these penicillin allergies, one of the big, big concerning clinical outcomes is more antibiotic-resistant infections. So you get more MRSA, you get more VRE, you get more ESBL, you get more C diff, like you get all these infections associated with antibiotic use, but also you get more of these really resistant infections.

SPEAKER_00:

That are harder to treat with routine antibiotics. Yep. And then you end up with that patient in the room with the scary bacteria that you were. Exactly. Yeah, yeah. Okay. All right.

SPEAKER_01:

And then the other, the other one I'll stress is the so aside from antibiotic allergies, that's, you know, we're living longer. We're able, like we have treatments for things that we didn't have a very long time ago. Well, one of the big things, especially in like the immunocompromised world, whether that's a transplant or chemotherapy and oncology patients, one of the things that happen with these patients is they get opportunistic infections. Well, those opportunistic infections, those can be antibiotic, or those can be from organisms that are just throughout the environment, or those can be just your normal flora decides to take advantage of your immune system being down. But this happens, this actually has happened three times this morning before we're recording this episode, is I got messages from my pharmacist and some of the physicians of like, I've never seen this bacteria before. Why am I seeing it now? Like, well, they have no immune system. They're profoundly immunosuppressed because of reasons XYZ. So this bacteria that has evolved, all these resistance mechanisms surviving in the environment, now has a host that it can cause an infection in. So they're like, oh, so what does that mean for me? I'm like, you've got two options. You've got two antibiotics left here because this thing has evolved so many different resistance mechanisms to allow it to survive in the environment. And it's just in unfortunate it's now made its way into a patient. So on one hand, it's exciting we can do liver transplants, lung transplants, and live much longer, but now you have to deal with the new threat of, oh, you've got all these opportunistic infections that can strike at any time.

SPEAKER_00:

Right, right. And as you say, as the population is getting older too, that also becomes more of a concern inherently. So I actually that I think ties nicely into sort of that study that's making some of these headlines because I think they looked at older adults in in long-term care type facilities. Um, but what's interesting about this study and why these headlines were getting interesting is because it wasn't about antibiotic use in that sort of population or concept, but also, you know, these non-antibiotics and whether they can lead to resistance. And so acetaminiphen and ibuprofen were some of the ones that got headlines, but they also looked at some of these other non-antibiotics. And I thought that was really interesting because that has never occurred to me before that a non-antibiotic could could increase that risk. So let's talk about that study and break it down a little bit. Maybe you can just give a high-level overview of what it was actually looking at and what you would, yeah, how you would summarize that for your colleague who asked about it.

SPEAKER_01:

Certainly. Yeah. So I think the first and foremost important thing to when you look at this study is it was all in vitro.

SPEAKER_00:

Yeah.

SPEAKER_01:

So oftentimes the first mistake I see people do whenever they see an article making headlines is they go straight to like, oh my gosh, this is gonna affect my patient's XYZ. Well, hold on. That's why there's a whole discipline of translational science of bridging that bench top research into clinical practice. This is a basic sciences article. So what this is, all this stuff is in vitro, all of this is there, yes, there's a patient or they have a strain of E. coli in there that's from a patient. All of these tests are occurring in test tubes. So this is something that I think it's a lot of fun whenever I have trainees on rotation with me. Uh, I ask them, okay, how does this piece of information you're looking at in this test tube translate to what's going on in your patient? And they're just like, I've never had to think this way. Like, well, you can only get so much education in your Farm D curriculum. That's why you're here on rotation is how do we apply this information? So stressing again, this is all in vitro, stuff in a test tube. Uh if you go towards, I want to make sure I cite it correctly. But when we talk about like the methods, like how did they do this? It was ah, figure two, uh, yeah, figure two, and then the graphic A. When you're trying to figure out like what on earth were they actually doing in this study, look at figure two, that section A, and that will walk you through like, oh, okay, there were these test tubes of this bacteria, and they put all this stuff in petri dishes, and then they PCR'd it. So, like that for those people who are like, I need a visual, like this basic science stuff is just way over my head. Just look at that, and that will walk, that'll give you a better visual of like what were they actually doing to come up with all these numbers? Because I'll be honest, I don't listen look at a lot of basic science research because I'm I'm applying a lot of stuff clinically. Like, I lean on my clinic on my colleagues that are translational science or scientists to help figure out like, you know, what what can I translate to practice? Whenever I look at this article, okay, a lot of this was there are all of these NAMs, or as the article calls it, or those make sure I don't misquote non-antibiotic medications.

SPEAKER_00:

I think is, yeah. Got it.

SPEAKER_01:

Yeah. So non-antibiotic medications were when and when they were saying what their list of what those medications were were things that are pretty commonly that you would use in geriatric patients. So let me zoom back out and and highlight that this article is looking at do these things commonly or do these non-antibiotic medications commonly used in geriatric patients, does that influence antibiotic resistance when they're given together? So it's and it's very specific to one antibiotic that they looked at, and that was ciprofloxicin. So whenever you're trying to think of if you're wanting to apply this to other patients and whatnot, like all they tested was ciprofloxicin and these non-antibiotic medications in combination with that. And we know fluoroquinolones, those antibiotics have a variety of antibiotic resistance mechanisms. Um, but we'll talk more about that later. Just remember, this is a basic sciences article.

SPEAKER_00:

Yeah. Yep.

SPEAKER_01:

All done in test tubes, not translational science just yet.

SPEAKER_00:

Yeah. And looking at the bacteria was E. coli, right? So, like a bug that would be treated with superfluxicin, but so basically saying that's an appropriate vehicle, right? To be looking at this sort of research if you were wanting to see if the mechanism of antibiotic resistance would happen. Would you say that?

SPEAKER_01:

Yes, I actually had to query some of my colleagues. That's like, is this the right strain that they chose and all this other stuff? Yeah. Oh, yeah. This like, I what is it, like K derivative of K12? Like that. That's how like deep I had to go into figure out, like, okay, so these are like lab strains that they're used. Like these weren't they had a lab strain and then this like clinical isolate like from a patient. Um how they figured out or how they chose this patient, I will tell you, I'm not looking at what strain of E. coli in clinical practice to apply this. It's like E. coli is E. coli, at least how I see in clinical practice.

SPEAKER_00:

Well, and and even like I I think the most important point that you stress is that this is bench study in vitro data, not human-based at all. And so I had referred to, you know, an older adult population, but really it's thinking about what drugs are commonly used in older adults, and that's how they decided which non which of these non-antibiotic medications to to narrow in on. And I'll just read those off. If it was ibuprofen, diclophenac, acetaminophen, furosamide, metformin, a torbostatin, tramadol, tamazepam, and pseudoophedrin. So sort of across the board of all these different drugs that are commonly used in older adults, and often, you know, this polypharmacy concept of people using multiple medications for various reasons. So that wasn't necessarily inappropriate, but in terms of what the findings were and how, again, these headlines sort of narrowed in on the acetaminophen and ibuprofen components. Can you talk a little bit about the the mechanism for why those two drugs in particular might have some might lead to antimicrobial resistance?

SPEAKER_01:

Certainly. So what they what they really stressed was there were really two types of resistance mechanisms that whenever they combined just these standardized concentrations of ciprofloxacin and the NAM, which in this case was ibuprofen or acetaminophen, they stressed, oh, there was an increase in mutation rate. And they were and when they did whole genome sequencing, which that's pretty impressive that they did that, that's a pretty pricey thing to do. Like I can't ask my clinical microbiology lab and say, hey, can you whole genome sequence sequence this organism because I have a question? They'll go, who's paying for that? So it's impressive that they were able to do that. But they really stressed that there were two resistance mechanisms that really were highlighted with the combination of that ciprofluxicin and those two specific OTCs of point mutations, which are like the gyrase A or drug efflux pumps. And that's the one that really caught my eye because efflux pumps are, and this is this might give people flashbacks to when they were in their micro course or pharmacy school in your ID section. But efflux pumps are just a bacteria's way of saying, you're in my cell, I don't like you, I'm gonna kick you out. And they're really good at you'll see this come up a lot, especially in other bacteria, of one, the efflux pump, whenever it's the bacteria is exposed to this one antibiotic, it'll make an efflux pump that can kick out more than just that, what that antibiotic was shown. So it doesn't surprise me that, oh, hey, this non-antibiotic that led to an upregulation in an efflux pump resulted in kicking out some other stuff. So that that doesn't surprise me. We know this there's an organism called Stenotrophimona's maltophilia, mouthful of an antibiotic, but I bring it up because this thing is like one of the masters of antibiotic resistance, and one of its main ways of doing it is efflux pumps. And if you throw fluoroquinolone at this bacteria, it generates resistance to like all the other antibiotics that you can use against it. So whenever they said, oh, it's an efflux pump causing the cross resistance, like I'm not surprised. That thing is like efflux pumps are very good at that cross resistance thing.

unknown:

Okay.

SPEAKER_01:

So you could have they, and this is where it's like when I start to look at their methodologies, like I'm not a basic scientist, but I'm also not surprised seeing those outcomes. Like they probably could have extended their list of non-antibiotic non-antibiotic medications, and they probably would have found some other things because this is a very understudied area. I'm not surprised that, oh hey, if we test enough things, it results in this efflux pump to get upregulated.

SPEAKER_00:

Yeah, and and I guess that was going to be one of my questions for you. Like this is one study has a lot of limitations as you talked about. Are there other studies out there that you know of that look at these non-antibiotics, not necessarily even the ones that they were looking at, but any non-antibiotic medications and risk of resistance with that? Or is this sort of like an emerging area of interest that more research may be done?

SPEAKER_01:

I would say this is definitely an emerging area because all through like my ID training and like since like all the various ID conferences I've gone to, this isn't a hot topic. This isn't brought up much. Okay. If anything, the thing that's getting a more interest is like phage therapy, or like how can we use this other thing to deal with antibiotic-resistant bacteria where we have no other options?

SPEAKER_00:

Okay. Okay, so so even more reason why maybe this new study doesn't necessarily change your practice that much. And that's gonna be my next question. So, how how would you apply this to practice if you would, and does it change your practice?

SPEAKER_01:

Certainly. So what after looking through all this, I'm not gonna pull this article out on rounds and say stop the ibuprofen, it's gonna make this E. coli more resistant. But what it does show, and this is this is the reason why I love the basic sciences, is it starts diving into an area that needs more research. So yeah, I mean, I would say the patients that have some of the most resistant organisms that I see, they're nursing home patients. They get rounds and rounds and rounds of antibiotics. This makes me start to think, I wonder if there are things other than the antibiotic exposure that are making things worse. Now, it does now. This also means I'm not gonna go in there and say, like, oh no, we're gonna treat this bacteremia with an oral switch option with ciprofloxasin, hold ibuprofen for the duration? Absolutely not. No, that's that's not how I clinically apply this. But it does start to ask the question of are there arms other than the non-antibiotic medications, other than the drug toxicity themselves, are there other consequences of it? So that's where like I really hope someone who's in the clinical in the clinical translational sciences looks at this and goes, I wonder if I compared a polypharmacy group to a non-polypharmacy group and look at antibiotic resistant outcomes on their infections. That's where it would start to raise the question of, ooh, this might be more clinically applicable. Of, hey, you know what, you're being treated for these infections, you have or you have this infectious disease state that have that's probably gonna have a long exposure of antibiotics or likely is going to result in multiple treatment courses of antibiotics. You are someone who's even higher risk, or you're someone who would benefit even more from seeing like a de-prescribing clinic compared to someone who's not. So definitely those that are in the like de-prescribing clinic, this is something that I would start to think of like, hey, you know what, this is an area that's starting to get more research. It's all the more reason that we should be investing in de-prescribing options.

SPEAKER_00:

Absolutely. And I I mean, I think for me, that was what I took away from this, even more than you know, the specifics around the specific drugs they looked at and what the outcome was. It was about using this as another cue, another prompt to think about appropriate medication use, which as pharmacists we're doing and thinking about all the time. But, you know, especially for those patients who have multiple medications for whatever reason, it's just such a good reminder of the importance of, as you say, de-prescribing, doing those comprehensive med reviews, looking at opportunities for optimizing therapy in in a bunch of ways. And that could be, again, from de-prescribing, it could be from reevaluating what analgesics they're using and if that's the most appropriate choice for that given patient. So it's it's a cute for both the antimicrobial uh stewardship sort of perspective, but also from the appropriate pharmaceutical use in general, which I which is uh what I love taking away from this study. Like, this is a good opportunity patients are asking in particular to be able to have that conversation. So, would you agree with that sort of like you know, thought process? And and if a patient was asking about this in your practice, how you would handle that? Like, would you then use it as an opportunity to have some of those discussions?

SPEAKER_01:

Absolutely, yeah. And I'm and there's I would say you'll find people in extremes of the camps of, oh, I will change my practice based off of in vitro data, and you'll have some people that go, Oh, I will never use something that's in vitro to change my practice. Like, I I mean, I look at this as like this is definitely worth using as a tool to start having conversations.

SPEAKER_00:

Yeah, yeah.

SPEAKER_01:

Like if I had a if I had a patient that had a laundry list of medications, like they're from a nursing home and have a mar of 30 meds, and they're and we're talking about like de-prescribing. This is absolutely an article I would I would bring up of like, hey, you know what? In in the near future, we'll probably see more studies that bring to light more the the harm associated with failing to de-prescribe as it relates to antibiotic resistance.

SPEAKER_00:

But in terms of this study in particular, we can't walk away with this and say anything about you know the duration of how how long these meds might be used together and whether that increases risk or whether the timing of the dosing or the dose of these medications increases risk. We can't really take away anything from a human-based perspective that way, right?

SPEAKER_01:

Correct. Yeah. Whenever I when I look at this, like there's I have more questions, which I mean you should. You should walk away with the study with more questions than answers. But when I look at this, it's like, okay, if some NAMs resulted in like no mutations or there was almost like a protective effect, what would have happened if those were together? Because these patients are often on multiple things, and the study just looked at this drug or ciprofloxacin and this NAM, ciprofloxin and this NAM. Like, what would have happened if you combined something that was seemingly protective and seemingly worse? Like I would not be surprised if patients were taking both Tylenol or acetamenophine and and tramidol. So right, right. There, yeah, I have a lot more questions with that. And then especially like there, someone or actually, when I look at the altmetrics of the article, so which if people haven't looked at the altmetrics on studies, you totally should because I can look at the article right now and see 115 news outlets cited this article. So, like that's a very powerful tool to see like who's citing this, where is this going? Yeah, like it's been cited in another journal one time, but it's gone through 115 different news news outlets. So I can see like this is one of those articles so far that's making the headlines, but it's not really changing practice just yet. But it also did get published. Like, I think it's actually saying today is like the official oh last updated all metrics. My bad. I'm reading the wrong thing. But like 55,000 people have accessed the article. So like people are looking at this.

SPEAKER_00:

Yeah, yeah. Yeah. And you know, it's it's all of the news outlets I saw sort of were rehashing the same story, but I don't think any of the like if you sort of read down those those articles, you would get to the point that it was sort of a lab study, and maybe but how many people actually walk away with that? Being able to impact what they take away from the the overall, it's hard for I think people to understand the significance of that sometimes. So that's where we should come in and really educate, help educate.

SPEAKER_01:

Exactly. Cause this was, and maybe this is just the the the flashbacks of what happened with hydroxychloroquine and azithromycin, people saw the article and went, here's the treatment for COVID. And overnight, like I I remember being in the inpatient pharmacy watching hydroxychloroquine go on back order because everybody was in a panic to order it and all this stuff. So ever since that article came out, and granted, I was an appy student at the time, so like it's like, oh, some people can read an article and over-extrapolate really fast. Right. So I've definitely I definitely look at these articles that if they're making headlines, go, okay, hold on, before I start, if I before I try and incorporate this into my clinical practice, I need to look at this and either be like, yeah, I agree with what everyone's telling me, or be a voice of reason and go, hold on, what what is actually going on here? So part of what whenever not only not only my ID physicians, but some of the even my wife, family members, they were like, Hey, have you seen this article? It's like, well, did you open it and look at it? It's open access. You don't have to have special library access to read it. You can go and look at it. Yeah. And they're like, oh, it says I shouldn't be taking Tylenol or IB or I should be taking acetamenophen or ibuprofen when I'm on antibiotics. And then I follow up with, well, if you actually go read it, you'll see it's in a test tube. You'll see it was a very specific antibiotic, a very specific resistance mechanism. But these news outlets, like, if you click the article, they got their goal.

SPEAKER_00:

Yeah, exactly. And and you know, I I think a lot of their health literacy is an issue, right? So it's hard, it's very hard because it's a complex topic, like in terms of how they're describing the mutations and the resistance, and you know, a lot of complex, even you were throwing out some complex terms that I didn't know about. So, you know, it's like everyone's at a different level, and and for a lot of people to be able to type to take away that headline and then to be able to digest even the abstract from that from the the open access article is where we play such a critical role, I think, right, in in helping helping demystify some of that. So if you have a patient who comes up, you know, to the pharmacy is getting an antibiotic and not feeling great, say the antibiotic well, I guess what would your thought process be? So say, you know, antibiotic and maybe they're not feeling great and they're asking about using an analgesic. What would how would you How would you manage that? Like what would your steps be?

SPEAKER_01:

So first, that would that is the opportunity for a pharmacist to reinstill their role as an antibiotic steward. It is totally, and I remember seeing this when I was on my appy rotations and also working as a pharmacy entered into community setting. It is totally appropriate. If a prescription comes in for an antibiotic and the patient brings up that antibiotic and goes, hey, I read this article, that is a great opportunity to go, you know what? It doesn't sound like this infection needs treated. Let me talk with your doctor because there's there's so much. Like when we talk about antibiotic stewardship, a lot of the resources are inpatient when we need a lot more resources outpatient. And a lot of antibiotics are just in case prescribing. It's very easy to fall into the trap of, well, I don't, I want to, I don't want to run the risk of under treating an infection, but there's not a lot of thought that goes into the, oh, but this is this patient. Like what's the what are the harms of the antibiotic here? But also what's the global harm of antibiotic resistance? I think ever since there's been a lot more focus in, you know, our our role as humans with the world around us, with the environment, that conversation's much easier to be had. I remember it blew my mind, but it was such a fun conversation with with this one patient. They asked about it, just again, this blew my mind. Maybe it'll blow everybody else's mind, but they're like, what happens to the antibiotic when I go use the bathroom? I was like, you know what? That's a really good point. And so we were we were talking about how, like, oh yeah, whenever because in this case they were they were on ciprofloxicin, which is very applicable to this because that's what this article talked about. And I remember, I think, recently learned that they were finding very, very small amounts of antibiotic in the soil. They're like, Well, how did how did this antibiotic get into the soil? Well, there's all these antibiotics that are used in veterinary medicine or in the antibiotics that are used by patients, make it to the water supply, and yeah, we're not able to completely remove it. So you just go out randomly sample soil and find, oh my gosh, there's antibiotic here.

SPEAKER_00:

Yeah.

SPEAKER_01:

No, no wonder we're finding bacteria in the environment that are resistant to these things.

SPEAKER_00:

Absolutely.

SPEAKER_01:

And of course, I like freaked her out about the antibiotics. I was like, no, no, if you have an infection that if you have an infection, your physician has diagnosed you with an infection, and it sounds like a real infection, which again, this is where it gets very difficult. Of, you know, we are as pharmacists, we're trained on the treatment. We're not trained on the diagnostics. So it's a very it's part of an area why some pharmacists don't like to do antimicrobial stewardship. They're like, I don't, I don't like challenging the physician on their diagnosis. Like, well, you shouldn't. You should just clarify the diagnosis because you can very quickly find out, oh, are we treating like for urinary tract infections? It comes up all the time. Do they have symptoms of a urinary tract infection? No, oh, but there's a scary bacteria growing in the urine culture. Yes. You're treating asymptomatic bacteria, you don't need antibiotics.

SPEAKER_00:

Very different.

SPEAKER_01:

Exactly. So it's made it so much easier to have that conversation of like, oh, okay, well, it sounds like so your diagnosis was UTI. Can you clarify that diagnosis for me? Was it cystitis? Was it pylonephritis? Was it just asymptomatic bacteria? And you saw something really scary, but they have no symptoms. That the physicians I work with, like ever since I've adopted that approach and I've taught the pharmacist around me that, they're like, hey, antibiotic stewardship isn't that hard. And the physicians aren't getting mad at me for telling them, hey, this isn't a UTI. Like, there's a reason why physicians are really good about saying, Where'd you go to med school whenever you approach stewardship that way?

SPEAKER_00:

Well, and it's it's it's a very nobody wants to be using more drugs if they don't have to. And, you know, I think that if if we can find a reason to be helping with that appropriate use, that can go a long way. And in working with colleagues and also with patients, too, because you know, I uh it's difficult for patients, I think, because they may be looking for some solution. Um, and that's the hard part, right? If it's a cold or a flu, or not necessarily flu, because there are antivirals for flu, but for cold, a common cold, you know, and helping educate about other management strategies, you know, that that can be very challenging, especially if they've already been prescribed something. But I do think it's worth the conversation, as you said. Like this is a cue, especially if they're wondering about some of this data, late this recent data, you know, this is a cue to have that conversation. And then also I think having the conversation about appropriate OTC analgesics, right? Because pharmacists are in a prime position there where some patients may not be good candidates for an OTC analgesic and some might, and or how you use it might might vary, but just a really good opportunity for for education here. And also I think for education around infection prevention, right? So, so washing hands and vaccines and all of those great things that we, you know, this time of year in particular, want to be reminding patients about.

SPEAKER_01:

So absolutely. And the other thing I'll round out with that is anytime there is a question about do I need this antibiotic or should I use this other therapy with it, it all comes down to a risk-benefit assessment. Yes. And I, my ID physicians get so annoyed when I say this because they know I'm right, but it's and sometimes it's more work. But having that shared decision making, oh my gosh, it makes it such an easier conversation of look, I'm happy to talk to your physician and have this conversation, but what are you more worried about? Are you more worried about the risks of the exposure of the antibiotic? Or are you more worried about the risk of under treating an infection? Because I wasn't in the I wasn't in the appointment when you two were talking about this, but I like I am the medication expert. I can help speak to you about the risks and the benefits of using this specific treatment for this specific indication.

SPEAKER_00:

Yep.

SPEAKER_01:

And I it goes, it's yeah, it's a much better conversation rather than oh, your doctor's so dumb that they prescribe this, like one, you know, bad, bad mouth other healthcare professionals that just creates mistrust in the healthcare system.

SPEAKER_00:

It's a collaboration and just again with your role and having a different perspective and having that shared decision making with the patient and just again having that conversation. So we're almost out of time. So, how would we wrap up today with a game changer? What would you say are the game changers from this topic? One or two game changers that a pharmacist should walk away with this discussion and apply to their practice.

SPEAKER_01:

So I'd say the game changer here is, you know, we're we're learning about something that we didn't really know much about before, that there's probably more harms out there that we're starting to learn more about. You've got another opportunity to have the conversation about antibiotic stewardship with your patients, but it's not, it shouldn't change your, it shouldn't change your management. It shouldn't change, don't go out there and say you can't use ibuprofen anymore when you get infections being treated. That that's not what this article is. The the game-changing aspect of this article is oh wow, there might be something that we are we're starting to learn more about an area that we didn't really know much about before as it relates to the impacts of non-antibiotics affecting antibiotic resistance.

SPEAKER_00:

Awesome. Well, great summary. And yeah, definitely learn something from this discussion because just to even have, as you say, have it on our radar, be aware of it as sort of this emerging potential area, but also using it as an opportunity to have those useful conversations with patients. So thank you so much. Of course. Really appreciate your expertise on this. And I'm so glad that you had the chance to share some of your practical experience with us.

SPEAKER_01:

Of course. Happy share. Awesome.

SPEAKER_00:

Well, listeners, be sure to claim your CE credit for this episode of Game Changers by logging in at CEimpact.com. And as always, have a great week and keep learning. I can't wait to dig into another game changing topic with you all next week.