SIDP Is Shaping the Next Era of Infectious Diseases Treatment

In an interview to celebrate the Society of Infectious Disease Pharmacists’ (SIDP) 35th anniversary, Erin McCreary, PharmD, BCIDP; and Mike Dudley, PharmD, highlight the evolution and ongoing importance of infectious diseases pharmacy and antimicrobial stewardship over the past several decades. They reflect on how the field has grown from a small group of specialists with limited treatment options into a globally recognized discipline shaped by advances in drug development, pharmacokinetics and pharmacodynamics, and increasingly complex resistance patterns. They emphasize the critical role of pharmacists in optimizing antimicrobial use, supporting patient care across diverse settings, and driving education, research, and policy.

Although significant progress has been made—including expanded training programs, new therapies, and greater integration into health systems—challenges remain, particularly in ensuring appropriate access to innovative treatments, addressing gaps in workforce training, and navigating the evolving landscape of antimicrobial resistance and drug development.

Pharmacy Times: Can you introduce yourselves?

Erin McCreary, PharmD, BCIDP: Hi, my name is Erin McCreary. I'm an infectious diseases pharmacist at the University of Pittsburgh Medical Center [UPMC] in Pittsburgh, Pennsylvania. I cover all 37 hospitals within the UPMC system, doing antimicrobial stewardship and infectious diseases care, leading a team of almost 50 stewardship pharmacists, and I currently serve as the president of SIDP.

Mike Dudley, PharmD: I'm Mike Dudley. I'm formerly president and CEO of QPex Biopharma. I've stepped into semiretirement mode. I spent over 30 years in industry developing antimicrobials and also a little bit on the commercialization side of them as well.

Prior to my career in industry, I spent about 15 years in academic clinical pharmacy practice and…starting in the…late 1980s, really started what is now called antibiotic stewardship. We called it antibiotic management then, but it was sort of the same idea. I was also one of the founding members of SIDP back in 1991.

Pharmacy Times: Looking back to when SIDP was founded, what were the biggest gaps or needs in infectious disease pharmacy that the organization aimed to address?

Dudley: It was an interesting time…in 1991, there was, well, maybe I'll start even back in the '80s. There were really just a handful of pharmacists with an interest in infectious diseases and antibiotics. And a couple of things were going on at that time. One was that, shockingly, in the 1980s, we didn't have a lot of classes of drugs to work with. We had basically…β-lactam antibiotics, we had aminoglycosides, and we even used chloramphenicol in a lot of cases…IV [intravenous] chloramphenicol in a lot of cases where we couldn't administer aminoglycosides. We hadn't even rediscovered polymyxins yet.

So, it was kind of a strange time. And then all of a sudden, there was a real renaissance of introduction of β-lactam antibiotics, primarily the cephalosporin antibiotics, the extended-spectrum cephalosporins; a drug called cefotaxime, which I think is rarely used now, was the first one of those. Another drug known as moxalactam, which was the first antipseudomonal β-lactam, was introduced as well. And so there were lots of antibiotics coming onto the marketplace for use. And then we still had the problems of trying to manage aminoglycoside toxicities, and so forth. So that was coupled with the idea that, in 1983, how hospitals were being paid for inpatient care changed, and it changed to the system of capitated payments. Many of the listeners here will know about DRGs [Diagnosis-Related Groups]. They started in 1983, where we were capitating payments to hospitals for inpatient care.

Now, why would that matter for antibiotics? Well, in the 1980s, the single biggest line item in a pharmacy budget was antibiotics. And so that fact, plus new drugs, plus now this new capitated system, started to bring forth a lot of weird policies on how antibiotics were going to be used in hospitals and restricting their use in formulary battles to get drugs on the formulary. And it really called for a lot of real expertise that, quite frankly, the pharmacy department was sort of being looked to for leadership roles in that way. And so we recognized that there was going to be an increasing need for this. And, like all good professionals should do, we realized that we couldn't just have somebody who decided one day that they're going to be an expert in antibiotics to raise their hand and start giving advice, whether it was on individual patients or whether it was on policy. So, like good professionals, you have to self-regulate. So we recognized that there was going to come a time where we needed to really regulate ourselves through some sort of certification or educational process. We needed to ensure that there were going to be qualified people in training programs to do that. And then we also had increasing interest in research, both practice-based research, but also in terms of scientific research on how these drugs are being made.

McCreary: I can say what hasn't changed, right? I can say 35 years later, SIDP is celebrating our 35th anniversary. That's why we're here talking to you today. And still, the need for robust antimicrobial stewardship and infectious diseases knowledge, expertise, and education remains.

And SIDP offers an antimicrobial stewardship certificate, which is still one of the lifebloods of our organization. We have a committee of almost 100 volunteers that maintains that stewardship certificate. We have thousands of enrollees across the globe annually. And we continually update, refine, and revamp those modules, and try to provide robust training.

I think one thing that has not changed but has expanded is that in 1991, a group of like-minded individuals in the United States was identifying a need to optimize the use of antimicrobials and bring people together to support that work. And now we're seeing that across the globe. And so the United States has a really robust infrastructure for pharmacist training in the form of pharmacist residencies. And even despite having that, we still don't have enough residency positions to train everyone who wants to do a pharmacy residency, so we still have room to grow. It's not like medicine, where you go to med school and 98% of people match to a residency because there's a 1-to-1 there with school and then residency positions.

Unfortunately, we still have room to grow with residencies. That's something SIDP tries to support. We fund 1 to 2 resident positions a year through grants. We give hospitals enough money to pay the salary and fringe of a resident to continue to try to grow these training programs in infectious diseases, but we're seeing in countries around the world and with partners like ESCMID [European Society of Clinical Microbiology and Infectious Diseases] and other global societies that they recognize the value pharmacists bring to the patient care team and the need for structural support to train them in antimicrobial stewardship and infectious diseases pharmacotherapy, especially the principles of PK/PD [pharmacokinetic/pharmacodynamic] antibiotic optimization. So that hasn't changed, right? That's the core of what we do; optimizing antimicrobials is the lifeblood of what infectious diseases pharmacists do.

But we are really working...we actually launched a task force in our society 2 years ago, which is now going to roll into a full-fledged standing committee in our organizational structure focused on this global training of pharmacists. What does that look like? Countries like Australia have really come a long way in PhD programs for pharmacists, but a lot of other countries don't have [infectious disease] pharmacists, don't have this training pathway, and so we're just continuing to try to expand from there.

Pharmacy Times: How would you describe the evolution of SIDP’s mission and impact over the past 3½ decades?

Dudley: I have to say…we evolved away from just being a bunch of White guys, who formed an organization back in 1991. We've got, I think, better leadership now in terms of a better organization because we’ve really brought along, I think, the next generation and more representative of all sorts of different backgrounds and views now. So that really has been a key part of what SIDP has done.

The other thing I'll touch on, and Erin mentioned this as well, is that susceptibility testing has gotten much more complex. Resistance is much more complex than it ever was back in 1991, and I would even hazard to say that other than MRSA [methicillin-resistant Staphylococcus aureus], there really wasn't a lot of resistance, at least the problems that we talked about.

We wanted to replace aminoglycosides. We thought they were a pain in the neck to dose. They were monitoring levels and so forth. Vancomycin [had] the same sorts of problems. So we wanted better drugs, didn't necessarily need new drugs to address the resistance problems like what we had now, but we just needed better drugs to treat the problems then. Now it's become so complex, both with susceptibility testing, differences in the international scene, [and] increasing use.

I was out there in 1987 when ciprofloxacin was launched, and this was a revolution in terms of being able to treat infections that used to require IV antibiotics, treating Pseudomonas infections with an oral agent, and we suddenly had to figure out, "Well, who could actually receive these drugs? Who could receive them from the standpoint of actually being able to take oral therapy? Where are we going to use them?" and so forth. So that really also drove the evolution of the kinds of practice.

There was always a little bit of friction, and I think...since clinical pharmacists in infectious disease came out of the pharmacy department, there was always…sort of a cost containment police thing that was always whispering in your ear. And access to antibiotics was a problem, I think in those early days, and we may not have addressed that as well as [we're] doing now, and we'll talk about where I think that's going in terms of this. But I think it's evolving out of the pharmacy and more into questions about quality of care.

McCreary: I'll tell you what hasn't changed. We still don't know how to dose aminoglycosides; we're still bad at it.

The Society of Infectious Diseases Pharmacists has actually commissioned...when we identify a gap in...wow, we do this commonly or not commonly, but enough that it, it requires a real deep dive and not guidelines, but they're not great evidence, but we call them Insights From SIDP, and we actually have an author group right now working on insights about aminoglycoside dosing guidance because there actually isn't an international consensus guideline or document on how exactly to dose aminoglycosides.

What has changed, I think our knowledge and understanding of PK/PD. So I think we go back to Bill Craig[, MD,] and some of the early pioneers, nonpharmacists actually, in the pharmacokinetics and pharmacodynamics space, and understanding antimicrobial exposures to how they act to kill organisms. That field has just exploded. I mean, just brilliant people that really deeply understand this concept, so much so that now PK/PD principles are incorporated into drug development, which is a huge win in terms of optimizing them from the get-go and having max doses approved, max tolerable doses. So, that's definitely something that's evolved with antibiotic development and something we continue to be the lifeblood of what ID pharmacists do and what people like Mike develop, right? And that goes hand-in-hand.

To level set for anyone watching this still at this point who's interested in me and Mike, the mission of SIDP is to advance infectious diseases pharmacy through collaboration, research, and education; lead antimicrobial stewardship; and then optimize the care of patients with infections in every practice setting. I don't think that's changed in 35 years. Our vision is safe and effective antimicrobials for now and the future. Also hasn't changed in 35 years. I think what's changed, though, are the pieces of that. So, [in] every practice setting, we started inpatient, hospital, formulary management, drugs, cost.

Now, the things [infectious disease] pharmacists do astound me every day. I learn of people in these really cool jobs in industry, in clinics, in not just like OPAT [outpatient parenteral antimicrobial therapy]...OPAT was revolutionary 20 years ago, but not just outpatient IV management, but now complex oral therapies, NTM [nontuberculous mycobacteria] practices, tuberculosis advocacy.

I literally had an SIDP member text me today and say, "Hey, I'm on the board for this eradicating tuberculosis society, can I be connected with the SIDP Political Action Committee? Like, these things are so amazing, right? And so that, I think, has not changed but just grown in [infectious disease] pharmacists moving into these new frontiers of work.

And the other probably major change over the past 35 years is how health care has systemized. And so all of us used to work at a hospital, maybe. And then, you know, 10, 15 years ago, we started working in clinics, and we started to expand to outpatient, retail, of course, and a few other things. But now, there are very few stand-alone hospitals, right? Almost everyone is affiliated with some kind of bigger infrastructure. And if you are a stand-alone, you won't be for long. I mean, that's just kind of how health care is moving for the way the ecosystem works. And so, positions like mine are actually common now, which is really cool.

There are dozens of infectious diseases–trained pharmacists who have moved into the system oversight roles of leading either stewardship or even just clinical pharmacy practice, across that. And I think stewardship-minded pharmacists tend to be administratively strong because there's a lot of paperwork with antibiotic stewardship, if we're being honest. It's a joint commission requirement. You have to show NHSN [National Healthcare Safety Network] reporting data. And I think that's the other thing that's changed, and we haven't directly mentioned it yet. But obviously, one of the biggest impetuses to continue to elevate our profession was the 2017 requirement for antimicrobial stewardship.

When it becomes a regulatory requirement, people care, people listen. And that is so important for patients. And so we're so thankful they recognize how important stewardship is for patients. But that made every hospital in the country that's Joint Commission–accredited have a drug expert in infectious diseases pharmacotherapy. That really led to expanding SIDP. I found out yesterday, as of March 2026, we are greater than 2400 members, which is wildly cool.

Pharmacy Times: How has SIDP supported pharmacists in adapting to an increasingly complex infectious disease landscape?

McCreary: We have a lot of really cool resources on our website, and I will say this is where our partnerships with industry and with media outlets such as yours really do help.

So we've had a long-standing partnership with Pharmacy Times. We write 6 articles a year where you publish those and gives us an opportunity to mentor and coach up-and-comers who maybe haven't had a first PubMed-cited publication yet. But we pair trainee students, new practitioners, with seasoned pharmacists who write really thoughtful, targeted education on new antibiotics, use cases, whatnot, and publish in outlets like Pharmacy Times. We have a very similar partnership with Contagion, another excellent media outlet, and things like that. Our industry partners will partner with us to create education materials. We do toolkits, we do infographics, we do development. We'll do social media campaigns with the goal of helping people understand how to use antibiotics.

For example, there's an antibiotic that was developed recently that has 2 unique components, and it comes in multiple vials by nature of how it was developed. That's a little different. You know, we're used to 1 drug, pop it on a Mini-Bag Plus, hang it. And so we wanted to make sure that people understood the packaging of this antimicrobial, and that sounds so silly, but these are the kinds of things that it's very easy to make a patient error if you don't understand this package that looks different than this package. And so we're creating an educational microlearning YouTube video on how to compound this drug. We try to be very creative across the organization. We try to constantly give members opportunities to do this kind of work, to educate the public for free.

I guess the biggest thing is that in 2018, we launched a podcast, and that is probably one of our most accessible free public education tools that focuses on infectious diseases, antimicrobial dosing, and pharmacotherapy. We publish 18 to 24 episodes a year. Mike's been on the podcast many a time, and it's called Breakpoints, and that is a resource our society offers to help people make rhyme and reason of all the antibiotics that have come out in the last several years, which is a good problem to have, right? We love new antibiotics.

Pharmacy Times: What innovations and new treatments are coming up that pharmacists and health care professionals should keep an eye on?

Dudley: A couple of things come to mind, both on the treatments, and then I also want to touch on how we evaluate these treatments as well, that I would look to the roots of SIDP to pick up and guide the professions in terms of being able to do that. One is that there are a lot of new types of therapies; [they are often] called nontraditional therapies. I don't like that term, but they're other than direct-acting antimicrobials.

There are going to be drugs that are going to be able to perhaps attack virulence mechanisms in bacteria or viruses. There are going to be those that are working, people talk a lot about phage therapy. I don't know whether phage therapy's ever going to really get there. It may get there more if you think about individualized therapy, like we think about individualized cell-based therapy in cancer; that may be where phage is going.

So, for example, when you have patients who have had a prosthetic joint infection or some kind of deep infection where you're going to have to essentially give long-term therapy, and you have time to individualize therapy, then I think you can think about perhaps ways that you could use phage-directed therapies as an adjunct in those systems. And so I think pharmacists have been involved in a lot of those evaluations that have taken place to date.

The other area I think is really exciting is in antiviral chemotherapy. We've gotten better antivirals. I can remember one of the things that SIDP was also involved in was back in HIV therapy. We had crummy drugs when they first came out. The nucleosides were terrible drugs for patients, caused all sorts of bone marrow toxicities, neuropathies, and so forth, and we've got better antiviral drugs for obviously treating HIV. We now have better antiviral drugs for treating everything from CMV [cytomegalovirus] to direct-acting antiviral agents that are going to be the foundation of influenza prevention going forward, which I think is very exciting.

[There is] a drug under review right now by the FDA, which is for use for postexposure prophylaxis in COVID-19. And with all the controversies about COVID-19 vaccines and efficacy and so forth, being able to now manage individually postexposure prophylaxis with a drug in high-risk individuals or household contacts is going to be great. So all of those are going to really change the paradigm in terms of how we start to think about those newer technologies. On the flip side of that, I think there are a lot of points made about the antibiotic pipeline and the problems with the antibiotic pipeline and the challenges in getting there.

I think one of the ways that the field has done a bad job, and it's not the pharmacist field per se, but industry has done a bad job of actually expressing what the societal value of antibiotics is. You know, we say, "Hey, antibiotics are really valuable, right? OK, I’ve got to go catch my bus because I don't have time to tell you how to measure that or why that's important." And I think there are going to be a lot more, better tools that are coming down the line to actually express the value that's going to help with that reimbursement or that payment problem that we have under the current system, so that our best antibiotics become available to patients.

Right now, I think there's too much restriction that takes place…we're not getting the right drugs to the right patients at the right time. Erin taught me something a few years ago that I'm going to repeat: "Patients shouldn't have to fail 40-year-old antibiotics to get the most current technology first." And so being able to get access for patients in all sorts of settings to the right antibiotics is going to be important.

McCreary: I mean, not much to add. I'll just say that, when I was in pharmacy school, there were no drugs for hepatitis C outside of interferon and ribavirin. Now, hep C is curable in 8 weeks with, like, 15 different options, right? In terms of direct...not only is there 1 drug, there's multiple, and they get better with each iteration. And multiple companies produce them, so we don't have to worry about them going away or manufacturing issues or shortages, which is also something we deal with and is really challenging, right? And that's a huge role of ours, actually managing antibiotic shortages and antiviral shortages and whatnot. So when you just think about the science behind that and think about the implications behind that...

I'll leave it with antimicrobials are the only drug class that use in a singular patient actually impacts their use in other patients, and that is really medically complex when you actually try to walk through it, and I don't think people really fully get it, even though they kind of get it.

And we see this in qualitative data. You will interview physicians or APPs [advanced practice providers] or pharmacists and say, "Is antibiotic resistance bad?" Yes. In the year 2026, most people can get there, right? Most people are like, "That sounds bad." Even if they don't know what it is, they're like, "Resistance is not good in general," right? Has a negative connotation. But then you say, "OK, well, but is antibiotic resistance a problem for you or for your patients?" And people are like, "No. No, doesn't impact me," which is kind of human, right? We kind of default to the mean, and we don't want to think that disease or something could impact us, and we create this "them-vs-us" approach to disease in general, which is also really not good as a society. John Green talks about this in the book Everything Is Tuberculosis. It's actually a fascinating concept in that we put patients who have certain diseases in this kind of dichotomy in society, which is not so great.

But all that is to say, it's so important to think about antimicrobials like that because it's true. They're the only thing in medicine where using it for one patient is going to change how it works or impacts another patient. And then to take it even a step further, infectious diseases are one of the only things where, if you help a single patient, you can actually help the population.

Hep C, case in point: If you are curing more hepatitis C liver disease, other people with idiopathic or genetic liver disease are more likely to get a liver transplant, because you took all these patients off the list because you cured their infection. And that is, I think, globally something that's probably still undervalued, and why we really advocate for the work that we do.

Pharmacy Times: Any final or closing thoughts?

McCreary: I'll just end with we're really excited. The SIDP/MAD-ID Joint Annual Meeting is in May in Orlando, so we hope to see everyone there. It's going to be a really good time, a couple of days of intensive [infectious disease] pharmacist-led content focused on antimicrobial optimization, and we'll be celebrating our anniversary.

Dudley: I would just add to that, we, of course, were quite bullish back in 1981, but, quite frankly, it was all about maybe surviving. I think it's been more about thriving. And I think...we never thought that we'd be talking about an organization with 2400 individual members now, as part of that, with a reach that's international, that's leading on the front of both training as well as policy. So that's been really exciting to see. I know the other founders are sort of flummoxed when they hear about these things as well, and I think it's been great leadership that this generation has brought forward, so congratulations, Erin, and everyone, and I'll look forward to seeing you in Orlando as well.