How do YOU use the Sanford Guide?

[pharm B]

So I just got my first copy of the Sanford guide since it's cheap and I figured it might be useful for Clinical Skills Competition. Also, I've seen people whip it out on a regular basis in hospitals. (Do what you will with that statement)

What do you guys use this for? Recommendations for empirical treatment on rounds is what I assume since you'd otherwise go by susceptibility results for drug and dose choice.

---

Members don't see this ad.

 

[Ndcyciv]

Renal dosing

 

[xiphoid2010]

So I just got my first copy of the Sanford guide since it's cheap and I figured it might be useful for Clinical Skills Competition. Also, I've seen people whip it out on a regular basis in hospitals. (Do what you will with that statement)

What do you guys use this for? Recommendations for empirical treatment on rounds is what I assume since you'd otherwise go by susceptibility results for drug and dose choice.

I use it mostly to decide on initial empirical therapy. It incorporates most of the current treatment guidelines, eg. Beta lactam + macrolide for CAP non-icu admit, with the alternative being a respiratory quinolone, ect. Also useful to look up 2nd and 3rd line when patients fail or can't tolerate that.

It also has a nice chart showing the relative sensitivity of various bugs vs meds, but the caution is that you should always correct it first using your hospitals antibiogram.

You just reminded me to ask for a free copy of the new Sanford when the zyvox rep comes knocking. Lol

 

[confettiflyer]

You just reminded me to ask for a free copy of the new Sanford when the zyvox rep comes knocking. Lol

i thought they were cutting back on that since sanford guide is one big giant book of unlabeled uses?

 

[Praziquantel86]

It's useful for empiric treatment of some things, but I would always verify the information and look into the clinical situation very carefully before you utilize its recommendations. It looks at syndromes/bugs at a very macroscopic level, so you always need to look at your patient's needs before picking an empiric drug and/or dose. A lot of the poor antimicrobial ordering I've seen is from housestaff taking Sanford at face value without really thinking things through.

The other thing to consider is that it is absolutely independent of what your hospital-specific data or local epidemiology would dictate. Always, always go with what your hospital recommends or antibiogram indicates as your guide to antibiotic choice.

 

[xiphoid2010]

i thought they were cutting back on that since sanford guide is one big giant book of unlabeled uses?

Evidence based medicine has its limits. You can't just point to lack of RCTs as reason to not use something. Most of the antibiotics have unlabeled use. There is no way you can do randomized control trial of each antibiotic for EVERY possible infection.

For example, we know that Primaxin, Merrem, Doribax are pretty much interchangeable, with a few minor differences here and there within 1-2 dilutions in MIC. Doribax hasn't got nearly as many indications as primaxin because it's the newest and got least number of trials, but you can use that with confidence in just about all the indications as Primaxin.

Anyway, I still have my 2009 sanford, but it's time for an update. The Zyvox and Tigacil drug rep is always so eager to drum up their sales here, and since I'm the new ID guy they better kiss my butt.... and they still won't get very far. LOL

 

[CUninja]

The other thing to consider is that it is absolutely independent of what your hospital-specific data or local epidemiology would dictate. Always, always go with what your hospital recommends or antibiogram indicates as your guide to antibiotic choice.

👍👍👍

 

[StewardshipDude]

Evidence based medicine has its limits. You can't just point to lack of RCTs as reason to not use something. Most of the antibiotics have unlabeled use. There is no way you can do randomized control trial of each antibiotic for EVERY possible infection.

For example, we know that Primaxin, Merrem, Doribax are pretty much interchangeable, with a few minor differences here and there within 1-2 dilutions in MIC. Doribax hasn't got nearly as many indications as primaxin because it's the newest and got least number of trials, but you can use that with confidence in just about all the indications as Primaxin.

Anyway, I still have my 2009 sanford, but it's time for an update. The Zyvox and Tigacil drug rep is always so eager to drum up their sales here, and since I'm the new ID guy they better kiss my butt.... and they still won't get very far. LOL

typical pharmacy attitude...reject everything as biased until a product loses patent, have disgust for MDs who meet with industry and then think you are immune from influence but expect an industry rep to provide you with a free Sanford guide...it goes both way colleague.

Don't bother with with the Pfizer rep, the JNJ rep or the Merck rep. Their companies signed with PhRMA so they can't give you anything outside of label.

Instead, get one from the Cubist or Forest rep - they didn't sign.

as has been pointed out, Sanford is good for ideas on empiric, that's it. Focus your brain on local resistance data, especially unit specific data and then move to the patient characteristics

but at the end of the day, what are you gonna do other than recommend generic pip/tazo, generic ceftriaxone, generic levo and vanc.

Carry on.

 

[Bob Benton]

So I just got my first copy of the Sanford guide since it's cheap and I figured it might be useful for Clinical Skills Competition. Also, I've seen people whip it out on a regular basis in hospitals. (Do what you will with that statement)

What do you guys use this for? Recommendations for empirical treatment on rounds is what I assume since you'd otherwise go by susceptibility results for drug and dose choice.

Table 1A: Initial Choice of Therapy
Important Caveat: Keep in mind the authors of the Guide know that clinicians in 50-bed hospitals and 1000-bed hospitals will be using these recommendations, so they write with the larger health systems in mind. If you don't practice in a location with a high level of MDR pathogens many of the recommendations in this table (IMO) tend toward overkill. (ex. for secondary peritonitis (pg 44 of the 2010 Guide) recommends Zosyn as the first ABX listed even though in most cases antipseudomonal coverage isn't necessary) Bottom line: temper these recommendations with your local antibiogram

Table 4: Comparison of antimicrobial spectra
Useful for answering the "Does X ABX normally cover Y bug" questions

Table 9A: Selected Pharmacologic Features
Occasionally useful for the "Does X ABX get in Y body space [e.g. CSF])

Depending on the size of health-system you work in the tables on antifungal therapy (Tables 11A-11C) and antiviral therapy (14A and 14B) can be helpful. In smaller hospitals probably less so

As an aside I don't use the renal adjustment chart in the Sanford Guide. I've seen a lot of discrepancies over the years with the information in that chart and PI information.

 

[confettiflyer]

Evidence based medicine has its limits. You can't just point to lack of RCTs as reason to not use something. Most of the antibiotics have unlabeled use. There is no way you can do randomized control trial of each antibiotic for EVERY possible infection.

For example, we know that Primaxin, Merrem, Doribax are pretty much interchangeable, with a few minor differences here and there within 1-2 dilutions in MIC. Doribax hasn't got nearly as many indications as primaxin because it's the newest and got least number of trials, but you can use that with confidence in just about all the indications as Primaxin.

Anyway, I still have my 2009 sanford, but it's time for an update. The Zyvox and Tigacil drug rep is always so eager to drum up their sales here, and since I'm the new ID guy they better kiss my butt.... and they still won't get very far. LOL

well no i know that, i'm speaking to the fact that the world of industry is strictly regulated as to what they can and can't talk about. so if you have a drug rep giving a book out with even a SINGLE unlabeled use, an enterprising lawyer can claim the company is promoting unlabeled uses.

solicited requests are different though.

hell, all the onco/transplant drugs are used off-label.

 

[Ackj]

their companies signed with PhRMA so they can't give you anything outside of label.

That's something that bothers me about drug reps now. I'm capable of reading the studies and insert on my own, and any questions that I'd have aren't able to be answered. Probably has something to do with the fact that close to zero reps are pharmacists anymore, but rather somebody with a sales record. If there was a way to have more qualified and knowledgeable reps, with the ability to interpret the data, that would be way more useful to all practitioners. Hiring some pharmacists for this role wouldn't be a bad idea.

 

[KARM12]

Sandford guide can help when you don't know where to start... I tend to look at it when I come across something new/strange. I think the bug/drug table is useful. The renal dosing table is not very accurate.

I take it with a grain of salt because some of the data in there is based on expert opinion and not always on the guidelines. As others have mentioned, it is no substitute for your hospital's antibiogram and your brain. You won't find anything related to stewardship in the Sanford guide.

The thing costs like $15...I hope you don't need to rely on a drug rep for one.

 

[confettiflyer]

That's something that bothers me about drug reps now. I'm capable of reading the studies and insert on my own, and any questions that I'd have aren't able to be answered. Probably has something to do with the fact that close to zero reps are pharmacists anymore, but rather somebody with a sales record. If there was a way to have more qualified and knowledgeable reps, with the ability to interpret the data, that would be way more useful to all practitioners. Hiring some pharmacists for this role wouldn't be a bad idea.

Those pharmacists are MSL's or work in the medical information department of the company and usually (depends) handle the solicited inquiries. You get a lot more leeway that way to discuss new studies & off-label uses as well as getting access to data-on-file.

It doesn't make sense financially to hire a PharmD and limit their discussions to the label, instead you hire a bright-eyed college grad to do that for cheaper and save your "bigger guns" for the med info/liaison side.