By Philip R. Fischer, MD, DTM&H

Professor of Pediatrics, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN

Dr. Fischer reports no financial relationships relevant to this field of study.

SYNOPSIS: Awareness of a patient’s and family’s belief system might help physicians appropriately frame explanations about the importance of antimicrobial stewardship.

SOURCE: Stokes L. The promise and failure of antibiotics. Christianity Today 2017;61:58-61.

Emergency medicine specialist Lindsay Stokes laments the growing global problem of antimicrobial resistance. For several years, she has been following the 20041 (updated in 20132) American Academy of Pediatrics’ encouragement to promote “watchful waiting” for select children with otitis media, giving them a prescription but suggesting that they only start antimicrobial treatment if the child is not improving after two days of just symptomatic care. So far, every family given a prescription has started antibiotic treatment immediately.

Dr. Stokes is not alone. Others around the world have noted poor compliance with the “no antibiotic” treatment plan, even though it is medically sensible and cost effective.3 Prior parental awareness of antimicrobial resistance and physician communication factors all influence the willingness of a family to withhold “treatment” for a crying child.4,5

“Stewardship” has become a buzzword for infectious disease specialists concerned with antimicrobial use. Stokes points out, though, that “stewardship” has long been a Christian term. (She is obviously writing mostly to Christians in a magazine called Christianity Today that is widely read by clergy and educated Protestants.) She explains to her readers that the World Health Organization is calling for a commitment to stewardship, emphasizing that we responsibly use what we have rather than seek new treatments. She notes that even microbes are part of creation and calls on her readers to accept the charge over creation to care for it. She urges that people who accept the “gift” of antibiotics also take care of them with gratitude to the creator.

Stokes reminds readers that they are to exercise stewardship over creation, according to biblical teaching. She explains that this biblical mandate makes them responsible for antimicrobial stewardship as well.

So, what does this mean for infectious disease physicians who might not read a Christian magazine and might not have considered what the Bible teaches about wise use of antimicrobial therapy? One relevant message might be that we should be aware of our patients’ perspectives. When we notice that they claim a biblical, evangelical, or Christian faith, we can remind them that withholding antibiotics for likely viral infections and that targeting antimicrobial choices is all part of the stewardship to which physicians and Christian patients aspire.


  1. American Academy of Pediatrics Subcommittee on Management of Acute Otitis Media. Diagnosis and management of acute otitis media. Pediatrics 2004;113:1451-1465.
  2. Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics 2013;131: e964-999.
  3. Sun D, McCarthy TJ, Liberman DB. Cost-effectiveness of watchful waiting in acute otitis media. Pediatrics 2017;139:1-9.
  4. Broides A, Bereza O, Lavi-Givon N, et al. Parental acceptability of the watchful waiting approach to acute otitis media. World J Clin Pediatr 2016;5:198-205.
  5. MacGeorge EL, Smith RA, Caldes EP, Hackman NM. Toward reduction in antibiotic use for pediatric otitis media: Predicting parental compliance with “watchful waiting” advice. J Health Commun 2017; doi: 10.1080/10810730.2017.1367337. [Epub ahead of print.]