When most people think about antibiotic stewardship, they consider preventing antibiotic resistance. This goal remains critically important because antibiotic resistance is a persistent threat to human health. In addition, there are other benefits that we don’t often talk about: reducing greenhouse gas emissions and other pollutants, decreasing cost, and increasing quality of life for patients.
Every unnecessary antibiotic prescription carries an environmental footprint. Antibiotics require energy-intensive manufacturing, packaging, transportation, storage, and disposal. When antibiotics are prescribed unnecessarily, these resources are consumed without improving health. Antibiotic production contributes to greenhouse gas emissions and unused medications become pharmaceutical waste. For antibiotics, healthcare professionals can help protect both patient health and planetary health by selecting the right drug, dose, and duration, and embracing diagnostic stewardship.
Diagnostic stewardship means choosing tests wisely. Such stewardship has been associated with decreased unnecessary use of antimicrobials. For example, doctors who order fewer chest x-rays to diagnose childhood bronchiolitis also tend to order fewer unnecessary antibiotics. Every laboratory test requires plastics, reagents, electricity, transportation, and waste disposal. Microbiology testing requires energy intensive autoclaving or incineration before samples go to a landfill. Refraining from ordering an unnecessary test saves money, saves patients time, and diminishes trash.
What about cost? The U.S. health system is one of the most expensive in the world per capita. Many of our patients experience financial stress from medical expenses. In a poll done in 2025, nearly half of adults said that they have trouble affording their healthcare (see figure). Decreasing unnecessary testing and treatment can help these patients. 
Every unnecessary antibiotic prescription carries an environmental footprint. Antibiotics require energy-intensive manufacturing, packaging, transportation, storage, and disposal. When antibiotics are prescribed unnecessarily, these resources are consumed without improving health. Antibiotic production contributes to greenhouse gas emissions and unused medications become pharmaceutical waste. For antibiotics, healthcare professionals can help protect both patient health and planetary health by selecting the right drug, dose, and duration, and embracing diagnostic stewardship.
Finally, we think about patients’ quality of life. We know that antibiotics are associated with diarrhea and other side effects. In children, we know that broader drugs like amoxicillin/clavulanate is associated with worse quality of life indicators as reported by parents. We know that antibiotics force many patients to go to the emergency department each year for real or perceived allergy or for other side effects. And we know about the risk for Clostridium difficile disease after antibiotic use.
Every health professional that I know entered medicine because they wanted to help people. Let’s help our patients and the public by thinking carefully before prescribing antibiotics.
References:
- Emily S Spivak , Jessica Tobin , Adam L Hersh , Alexis P Lee. Greenhouse gas emissions due to unnecessary antibiotic prescriptions, Antimicrob Steward Healthc Epidemiol 2024 Sep 4;4(1):e114. doi: 10.1017/ash.2024.354/
- Antibiotics and adverse quality of life: https://jamanetwork.com/journals/jama/fullarticle/2666503#google_vignette
- Image: KFF Health Tracking Poll (May 5-25, 2025).
 About the Author: Dr. Preeti Jaggi is Professor of Pediatrics and Infectious Diseases at Emory University School of Medicine, and Medical Director of the Antimicrobial Stewardship Program at Children’s Healthcare of Atlanta, Georgia. Her email is preeti.jaggi@emory.edu |
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