Good *Current* Source for ICU Antibiotic Management?

[IgM]

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Thoughts? I'm always hesitant to use hardcovers for this purpose because it seems like they couldn't possibly be current on what resistances exist right now, etc. Anybody have an online or handbook source they use for "real quick - my patient's culture grew this out, this is the best drug to use this year and this is how you dose it"?

Maybe this is a kinda dumb question, if so, please ignore.

 

[seinfeld]

Ask your favorite ID doc or PharmD for the hospitals/ICU antibiogram. This will give you your local resistance patterns and tell you how to choose empiric ABX.

What abx to use empirically are based on type of suspected infection (community acquired versus Heathcare associated), what location you suspect the infection (PNA vs Bacteremia vs Intraabdominal), and how sick the patient is ( outpt vs inpt vs ICU patient on the brink of death)

If you are a medical student i would suggest starting with a hard cover book. Learn which abx cover which type of bacteria, mechanism of action, which bacteria require special types of abx. After that then pick of a couple of review articles on the treatment of PNA, UTIs, Intrabdominal infections. After that then start to incorporate your hospitals antibiogram into individual decision making.

In general the sicker the patient the bigger gun then abx you start with empirically. Once you have culture results and sensitivities you narrow your choice down.

This is not something to be learned overnight and much of it is still an art.

 

[geogil]

Vanc, Flagyl, Zosyn. That's the cocktail taht pretty much everyone got where I went to medical school. I would get a Sanfords guide to ABx for this year and read up. It has spectra, and organ/disease specific organisms and tx. It's updated anually and should give you a good baseline for what the usual causative organisms are for most conditions. It's about $16 i think. It's also small enough to fit in your pocket. Not everybody likes the format, so spend a few minutes flipping through it to figure out how the information is arranged. Once you do, it's a great resource.

 

[soleluna]

Vanc, Flagyl, Zosyn. That's the cocktail taht pretty much everyone got where I went to medical school. I would get a Sanfords guide to ABx for this year and read up. It has spectra, and organ/disease specific organisms and tx. It's updated anually and should give you a good baseline for what the usual causative organisms are for most conditions. It's about $16 i think. It's also small enough to fit in your pocket. Not everybody likes the format, so spend a few minutes flipping through it to figure out how the information is arranged. Once you do, it's a great resource.

I also suggest a Sanford guide. It's very detailed for a pocket guide, and updated annually.

 

[pgg]

Ask your favorite ID doc or PharmD for the hospitals/ICU antibiogram. This will give you your local resistance patterns and tell you how to choose empiric ABX.

This is the best answer.

At a trauma unit where I rotated as a resident, the ID guys had a big whiteboard with things like "this month's empiric coverage for _____ is _____" written on it. They came up with a rotating scheme based on local resistance patterns. It's been a while, but I think at the time their gram+ drug had a 3 month cycle going through vanc, a carbapenem, and pip/tazo. ID needed to sign off on any use of a drug that wasn't the flavor of the month. I don't know how they got the surgeons to go along with that.

 

[WholeLottaGame7]

This is the best answer.

At a trauma unit where I rotated as a resident, the ID guys had a big whiteboard with things like "this month's empiric coverage for _____ is _____" written on it. They came up with a rotating scheme based on local resistance patterns. It's been a while, but I think at the time their gram+ drug had a 3 month cycle going through vanc, a carbapenem, and pip/tazo. ID needed to sign off on any use of a drug that wasn't the flavor of the month. I don't know how they got the surgeons to go along with that.

That is rough. ID must have some decent clout.

Seinfeld's advice is right on. Start with understanding organsims/mechanism of actions. The MMRS book is a decent "big book" to use, as even though it is corny some of the drawings/word associations will stay with you. Then, on the wards, a combination of Sanford and your local pharmacist is the best way to go.

For me, microbiology/antibiotics doesn't come naturally. I've gotten better at it as intern year has gone on, and you'll realize if you even give it half a shot to learn it, you'll be ahead of a lot of physicians who just fire off "vanc/zosyn" for the majority of patients (caveat: it's not too bad of a combo if you're in a pinch and not sure what's going on). Add cefazolin (for surg proph) and flagyl (for gut coverage), and I think those 4 basically exhaust the surgery repertoire.

In fact, I'm pretty sure ortho actually stops after the Ancef

 

[bigdan]

ID needed to sign off on any use of a drug that wasn't the flavor of the month.

Same here at Pitt. Pharmacy won't even dispense the drug unless you give them an "antibiotic approval number", which is a secret code the ID fellow or attending gives you after recommending a certain drug. You wanna treat some bug with a drug of your choosing? Fat chance 'round these parts.

I agree about asking the Pharmacists about the hospital specific drug guides - we get a pretty slick, bound and "published-looking" book from them...very helpful.

dc

 

[periopdoc]

Sanford (also available for ios), Johns Hopkins Antibiotic Guide (also available for ios, android, winmo, and blackberry) and the hospital antibiogram will give you all the info you need on the wards. I particularly liked the way that the JHU abx guide was structured for quick answers on the wards.

Combine these with a basic text on the pharmacology of antimicrobials and you will have everything you need for rotations from wards all the way through an ID sub-internship. (Combined with primary journal articles of course).

- pod