Several times a week Brad Spellberg struggles with a difficult decision. A patient stumbles into his emergency room in southern California suffering from familiar symptoms: pressure when she urinates, pain in her side, fever and nausea. Based on these clues Spellberg can quickly diagnose the problem as a kidney infection, but the trouble lies in deciding what he should do next. He knows the patient is hurting and of course he wants to help, but more than his patient’s health hangs in the balance.

Like any emergency room clinician Spellberg has two disparate options. The first is to treat the patient with a powerful antibiotic called carbapenem, administered intravenously. It would wipe out a variety of bacteria that might be causing the infection, but there is a catch. Deploying this precious resource may make it less likely he can use it to treat a future patient. READ MORE