It has been nearly a century since Alexander Fleming developed the first antibiotic, penicillin, in 1928. Today, there are many antibiotics available, and it’s estimated that they save millions of lives each year. Since their discovery, leading causes of death in the United States changed from communicable diseases like pneumonia to non-communicable diseases like strokes and cancer, and the average life expectancy increased from 47 years in the early twentieth century to 78.8 years today.
Yet, despite being incredibly effective at treating infections and saving lives, the continued use of antimicrobials comes with a downside — antimicrobial resistance. While this occurs naturally over time as pathogens learn how to adapt and survive, the timeline can speed up as antibiotics are used more and more. Drug-resistant pathogens that were once relatively rare are becoming more common.
In addition to the frequent use of antibiotics, the slowed pharmaceutical development of new drugs has compounded the antimicrobial resistance problem, so that patients with drug-resistant infections have fewer and fewer treatment options. Drug-resistant infections can lead to heightened risk for severe illness or death, especially in elderly or immunocompromised individuals, but also in otherwise healthy people if drug-resistant pathogens end up circulating more in the community. Antimicrobial resistance also threatens to set back many of the advances of modern medicine, such as surgeries, organ transplants, and cancer chemotherapy.
To mitigate this problem, Misha Huang, MD, associate professor in the University of Colorado Department of Medicine’s Division of Infectious Diseases, is stepping into a brand-new role for the UCHealth system: medical director of antimicrobial stewardship. As the new director, her mission is to optimize the use of antibiotics throughout the health system, ensuring that the right drug is used at the right dose in the right situation and for the right amount of time — basic tenets of antimicrobial stewardship that aim to maximize the success of treating an infection while minimizing potential harms of antibiotic exposure. This is an expansion of a role she held for the past eight years as the medical director of antimicrobial stewardship for the University of Colorado Hospital (UCH).
For Huang, who began this work not long after completing her residency and fellowship training at CU, the public health implications of antimicrobial resistance initially drew her interest.
“Even when antibiotics are prescribed for individuals, any antibiotic use has consequences for the entire community,” Huang says. “I was really interested in that intersection between individual and population health.”
This new role — which she began in March 2025 — expands her footprint beyond the walls of UCH and allows her to do more work in outpatient settings, where more than 80% of antibiotics are prescribed and 30% of those are prescribed inappropriately.
Huang says that this can happen for a variety of reasons. Sometimes it may be difficult to tell whether an illness is caused by a bacterial infection, versus a viral infection or non-infectious illness that does not require antibiotics. Other times, test results may be confusing for providers to interpret, because even a test that indicates the presence of bacteria does not always mean that an antibiotic is needed. And in other situations, providers may simply be too busy to keep up with new data and guidelines and have little time in a busy clinical practice to consider whether the antibiotic prescribing practices they're used to are still best for a patient’s current scenario. In all cases, Huang recognizes that providers are trying to do their best for their patients and is working in her role to help them do just that.
To improve antibiotic use, Huang will incorporate multifaceted antimicrobial stewardship interventions throughout the health system, including incorporating prescription decision support within the electronic medical record system, increasing clinician education opportunities, and developing patient awareness strategies. She also looks forward to partnering with front-line providers to develop innovative solutions to antimicrobial stewardship gaps.
Some of this work has already been tested at UCH and serves as a foundation for expanding across the UCHealth system. In addition to her work in the UCH inpatient space, a 2022 research study that Huang co-authored incorporated these interventions at a geriatric clinic. Within the electronic medical record, Huang and her team implemented antibiotic order sets for common infections. Once the provider selected the disease, primary and secondary antibiotic choices would pre-populate, followed by indications, doses, durations, and usage instructions. They also brought infectious diseases physicians into the clinic to provide in-person trainings to providers and displayed educational posters in patient waiting areas to encourage patients to speak with their clinicians about antibiotic use.
Following the interventions, the research team found that total antibiotic prescriptions decreased by 9.6% and the duration prescribed decreased for certain infections, suggesting that the low-cost and easy-to-implement solutions were initially successful in changing antibiotic prescription behaviors.
Huang says that what excites her about these interventions is the personalized approach to medicine.
“Antibiotic stewardship is truly personalized medicine,” she says. “Making the right antibiotic choice for each patient requires looking at the whole person — their symptoms, underlying diseases, allergies, previous antibiotic and pathogen exposures. It also requires educating the patient and empowering them to ask questions about the risks and benefits of their antibiotic plan.”
Huang notes that patients are becoming more aware of the problem of antibiotic resistance and superbugs. In her experience, patients are grateful to be able to talk to their provider about it.
Beyond scaling up the program, Huang also has an interest in advocating for national efforts in the fight against antimicrobial resistance. This includes advocating for policies that support antibiotic stewardship tracking and research activities, as well as policies aimed at helping to fix the antimicrobial drug development pipeline.
Antimicrobial drugs are not as profitable as other drug categories and there is little incentive for pharmaceutical companies to develop them. This means that these medications are becoming a finite resource, and when drug resistance outpaces drug development, there is a risk of running out of treatment options. Huang has already been to Washington on several occasions to advocate for better policies to incentivize antimicrobial drug development and hopes to continue this work in the future.