Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation




Pharmaceutical Sciences

First Advisor

Dr. Chris Delcher


The introduction of antibiotics into clinical practice is considered the greatest medical breakthrough of the 20thcentury. However, the use of antibiotics can contribute to the development of resistance. In the United States (U.S.), approximately 2.8 million people are infected with antibiotic-resistant bacteria each year, and more than 35,000 people die as a result. Moreover, some antibiotics are known to cause cardiac side effects including QT prolongation, hypotension, and ventricular arrythmias. The U.S. Centers for Disease Control and Prevention (CDC) defines appropriate antibiotic use as the effort to use “the right antibiotic, at the right dose, for the right duration, at the right time, and reduce unnecessary antibiotic use”. The aspects of CDC’s appropriate antibiotic use definition covered in this dissertation are antibiotic duration and reducing unnecessary antibiotic use in Chapter 2, and the right antibiotic at the right time in Chapters 3 and 4.

Chapter 2 and Chapter 3 contain summaries of literature regarding relevant scientific background, clinical background, historical context, and gaps in the literature. Chapter 2 additionally covers the biomarker intervention studied at UKHC, a pre-intervention cohort study, and a pre-post cohort study. Chapter 3 additionally includes a cohort study examining AZM exposure around a myocardial infarction and long-term cardiac outcomes. Chapter 4 includes a cohort study examining AZM exposure around a myocardial infarction and short-term cardiac outcomes. Finally, Chapter 5 discusses implications, future directions, and recommendations from the findings provided in this work.

Digital Object Identifier (DOI)