Eliminate prescribers’ uncertainty to catalyse the impact of vaccines on antibiotic use

Elizabeth T Rogawski McQuade and colleagues conducted a study to estimate the effects of Shigella, enterotoxigenic Escherichia coli, Campylobacter, norovirus, adenovirus, and rotavirus vaccines on antimicrobial use. They found that introducing a Shigella vaccine could prevent eight antibiotic courses per 100 child-years, resulting in a 1% reduction in overall antibiotic use. However, the authors argue that these studies underestimate the potential effect of vaccines on overall antibiotic use. Most antibiotics are used for disease episodes that do not result from bacterial infections, and unnecessary antibiotic use can stem from poor diagnostic capacity, prescriber uncertainty, and pressure from caregivers or patients. If new vaccines achieve sufficient effectiveness and vaccination coverage, all bacterial pathogens contributing most to diarrheal disease could be reduced, mitigating prescribers’ uncertainty. Implementation research could generate evidence on the potential of vaccines in reducing antibiotic use without overlooking prescribers’ and patients’ perceptions, uncertainty, and related behavior.