Antimicrobial stewardship has traditionally focused on optimizing antibiotic use to improve patient care, but growing attention to environmental sustainability is expanding how stewardship teams think about resource use. From the plastic waste generated during medication preparation and administration to opportunities to incorporate environmental considerations into antibiotic selection, stewardship offers a natural opportunity to address both clinical and environmental priorities.

Dr. Pam Lee and Dr. Gary Fong developed EcoRxChoice.com, a free calculator designed to integrate environmental metrics into antimicrobial stewardship. The calculator estimates the amount of plastic waste associated with different antimicrobial regimens by accounting for materials used in medication preparation and administration. In their paper published in ASHE, "EcoRxChoice.com— an SIDP-funded calculator integrating environmental metrics with antimicrobial stewardship," the authors describe how they developed the calculator, including physically weighing items ranging from IV bags and tubing to needle hubs and medication packaging.

In this episode, Dr. Lee and Dr. Fong discuss the origins of EcoRxChoice.com, the surprising amount of plastic waste generated through routine medication preparation, and how environmental impact can be incorporated into antimicrobial decision-making. They also explore the role of IV-to-oral conversion, the challenges of integrating sustainability into pharmacy and medical education and electronic medical records, and future opportunities to expand the calculator to other areas of stewardship and infection prevention.

Links and Recommendations:

• EcoRxChoice.com— an SIDP-funded calculator integrating environmental metrics with antimicrobial stewardship: https://www.cambridge.org/core/journals/antimicrobial-stewardship-and-healthcare-epidemiology/article/ecorxchoicecom-an-sidpfunded-calculator-integrating-environmental-metrics-with-antimicrobial-stewardship/83C55C51C9C446C4728FF1980CD2EC14
• https://ecorxchoice.com/?page=plasticWasteCalculator
• Development of a Novel Carbon Emissions Estimation Tool for Disposable Waste Associated With Antimicrobial Packaging, Preparation, and Administration in the Hospital Setting: https://academic.oup.com/ofid/article/12/10/ofaf308/8183152