Infectious Disease for Pharmacists?

[RxMckenzie]

Hi,
I'm just starting my rotations in June and I'm new to SDN. I am really interest in doing a rotation and eventually a residency in infectious disease. I was just wondering if anyone could tell me about their experience there. What should I do to prepare and what was your role there?

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[skwave]

I would like to know about this as well. There doesnt seem to be a lot of information about pharmacy and infectious diseases or even infectious diseases in general. Anyone with a residency in ID care to offer insight on what you do? Any practicing pharmacists in ID?

 

[Ackj]

From what I've seen on IPPE, review charts of patients on broad spectrum abx, and narrow it down. If they're on abx make sure they need to be, make sure they cover the likely pathogens, make sure the most likely pathogens are susceptible per your antibiogram. The hospital I was at would have sit-down rounds in the afternoon. An ID doc would come up and talk to the ID pharmacists and there would be some residents and students as well. As gram stains, cultures, and eventual susceptibility panels came back, therapy would get tweaked. Seemed pretty interesting, although I only saw a little bit of it since it was an IPPE.

 

[xiphoid2010]

Hi,
I'm just starting my rotations in June and I'm new to SDN. I am really interest in doing a rotation and eventually a residency in infectious disease. I was just wondering if anyone could tell me about their experience there. What should I do to prepare and what was your role there?

ID has been traditionally a weak area for students, and I too felt there wasn't enough class time on this very deep subject, leaving most students on rotation clueless.

The main things that will make you stand out is:
Spectrum of each antibiotics
Likely pathogen of each disease
How to kinetically dose Vanc and AG
Treatment guideline for the common infections
The key concepts of antibiotic stewardship

Knowing these will allow you to hit the ground running. You round with doctor and making recommendations. And for me, it's super fun, like a war with bugs, and for most cases you can see clear result in just 2-5 days. It's is very rewarding. But do note that it is not the clinical specialty with a lot of openings right now.

 

[bacillus1]

I'm currently on an ID rotation, and what Ackj wrote sums it up pretty well.

My mornings consist of working up patients from an ID standpoint. Have to look at radiology, cultures and labs that may help proper antibiotic selection (SCr, AST, ALT, etc...). All antiinfectives have to be assessed for proper coverage, dosage, frequency and duration, as well as any interactions with the patients' other drugs. I have to do vancomycin calculations for the patients on it and watch troughs. Then I usually do readings that my preceptor assigns for topic discussions (each topic discussion is on a different class of drugs, there are typically 2-3 per week). There is lots of reading on this rotation.

In the afternoons we usually go over patients and the topic discussions. Then I round with the ID team some days. Aside from seeing some of the patients on rounds, there is no patient contact. Besides the normal daily activities, I am also expected to present a journal club and a formal case.

 

[njac]

and remember that depending on the site, you're likely to see most "bread and butter" ID on your internal medicine rotations.

At a teaching institution, the ID rotation is often specific to patients being seen by the ID team - that is, those who are out of the comfort/scope of the primary team. So you'll see cool stuff, but not always practical stuff.

 

[Its Z]

ID is easy. Know your drugs and drug classes. Then know the bugs and diseases. Then know what drug kills what bugs. IDSA guidelines is the way to go.

Being a steward of antibiotics means cost effective approach to utilizing the available resources to attain the best clinical outcomes.

Pharmacists are best equipped to be a part of this movement.

Though PGY2 trained ID pharmacists are a tough bunch to manage because many of them feel that no one else knows ID.....Of course our own id pharmacist who likes to spin isnt that way.

 

[KARM12]

Though PGY2 trained ID pharmacists are a tough bunch to manage because many of them feel that no one else knows ID.....Of course our own id pharmacist who likes to spin isnt that way.

This is true...but most of my pharmacists don't know anything about ID.

Verifying ertapenem and cefepime at the same time, giving everyone vanco...if they would take 5 seconds to think about what they are verifying (or ask a question), it would save me hours of tracking down providers the next day.

 

[njac]

This is true...but most of my pharmacists don't know anything about ID.

Verifying ertapenem and cefepime at the same time, giving everyone vanco...if they would take 5 seconds to think about what they are verifying (or ask a question), it would save me hours of tracking down providers the next day.

Or my beef, giving the ER docs the 1gm of vanco they order on everyone. No! Bad! Think!

 

[Its Z]

Not my pharmacists!!!

We know ID!!

 

[xiphoid2010]

Not my pharmacists!!!

We know ID!!

Good. But I have to agree with KARM, most RPhs don't know ID from their badge. I blame it on the poor level of ID education during school.

 

[Its Z]

Good. But I have to agree with KARM, most RPhs don't know ID from their badge. I blame it on the poor level of ID education during school.

Not my school. And not my pharmacists.

 

[KARM12]

Not my school. And not my pharmacists.

Most be nice...

My staff pharmacists are at times the biggest hinderance in my stewardship program.

 

[Its Z]

Every one of my staff rotate clinical shift. And it works.

 

[SHC1984]

ID is the hardest class in pharmacy school. It's the only class I can NOT make an A in no matter how hard I try.

 

[skwave]

Wow thanks for the response guys! Since being in pharmacy school, Ive become quite interested in ID (I love micro and have some ugrad research in it). Im assuming the job market for such positions are bad and will prob not get better in the future due to the number of pharm graduates, but I really would like to pursue this. Does anyone have advice on how to stand out? Is research the best way? Residency?
Thanks a lot for your responses!

 

[KARM12]

Wow thanks for the response guys! Since being in pharmacy school, Ive become quite interested in ID (I love micro and have some ugrad research in it). Im assuming the job market for such positions are bad and will prob not get better in the future due to the number of pharm graduates, but I really would like to pursue this. Does anyone have advice on how to stand out? Is research the best way? Residency?
Thanks a lot for your responses!

If you want to be a specialist these days and do not have experience, you will most likely need a PGY1 and PGY2 to get your foot in the door.

I wouldn't say the job market is any different that other specialty areas. It just depends on where you are willing to live and a little luck of what is open when you are looking.

 

[xiphoid2010]

Wow thanks for the response guys! Since being in pharmacy school, Ive become quite interested in ID (I love micro and have some ugrad research in it). Im assuming the job market for such positions are bad and will prob not get better in the future due to the number of pharm graduates, but I really would like to pursue this. Does anyone have advice on how to stand out? Is research the best way? Residency?
Thanks a lot for your responses!

Study your ass off during school, have the drugs and bugs knowledge down. Its a lot of info but it is essential.

During P4, do lots of ID or ID heavy rotations (e.g MICU) will help you learn the basic clinical ID.

Do a PGY-1 at a place that offers ID rotations. I am biased in favor of VA because of pharmacist authority and very evidence/guideline based practice. Ideally you would move on to a PGY-2 in ID if you can.

You really need a PGY-2 to compete effectively for the jobs in larger insitutions. But some smaller or rural hospitals will still give a PGY-1 with significant ID experience (e.g, ~3 months worth) a shot.

 

[Glycerin]

Or my beef, giving the ER docs the 1gm of vanco they order on everyone. No! Bad! Think!

Oh, so ED MDs do this at other institutions, too? Hardly anyone gets a 1 gm dose, especially a loading dose. They must get trained to order it incorrectly.

 

[Glycerin]

Every one of my staff rotate clinical shift. And it works.

 

[Its Z]

Wanna move to CA?

 

[Glycerin]

Wanna move to CA?

Nope. Just bought a house. It's luuuurvely.

 

[Its Z]

Nope. Just bought a house. It's luuuurvely.

Nice! Get that garden going
Im officially homeless.

 

[Glycerin]

Nice! Get that garden going
Im officially homeless.

I have 2.2 acres. I think I can squeeze a garden in there somewhere. ;-)

 

[spacecowgirl]

Oh, so ED MDs do this at other institutions, too? Hardly anyone gets a 1 gm dose, especially a loading dose. They must get trained to order it incorrectly.

Ours do this too. And even though we have CPOE, it's often infusing before the order comes across our screen.

 

[Farcus]

Our schools has pretty in depth ID section taught by a ID specialist along with other specialists. I really like ID as well. For my 4th year I gotten as many IDish rotation as I can including: oncology, ID, transplant!