Need help with antibiotics...

[andrea]

So I am an intern and am having a hard time figuring out which abx to use for what. I admit I barely passed pharm and infectious in med school, and now it's coming back to bite me in the butt. The main way I am picking abx now is clicking on the ID category in Epocrates on my palm. I really need a better grip on this, at least so I can explain to my attendings why I chose what I did. This is embarassing, but can someone give me a list of common conditions and which abx you use, and also special circumstances. Thanks!!

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[Blade28]

Well it all depends on your instutition and residency type.

In surgery, for broad-spectrum empiric treatment, we tend to stick to certain drugs, a la:

Gram-positive: Ancef vs. vanc
Gram-negative: Zosyn vs. Unasyn (especially for biliary) vs. Levaquin
Fungal: Diflucan
MRSA: Bactrim or vanc
VRE: Zyvox
Cellulitis: Ancef (IV) vs. Keflex (PO) or Augmentin
"Triple coverage" (for ICU patients): vanc, imipenem, amikacin (thus double-covering for Pseudomonas, also covering for Acinetobacter)

 

[PharmD2MD]

hey- I'm just a lowly MS-2 now, but I was a pharmacist. I was looking at these posts to see what sort of misery lies in future. Anyway, I know the pain of antibiotics. There is a Dr. Jeff Guy at Vanderbilt- I think he's a surgeon/critical care/burn sort of doctor. He has a great pod cast series on I-Tunes, including one on antibiotic selection. You could listen to it on your commute or whatever. It's free. Another resource that I like is the the Medical Letter Treatment Guidelines. They do a great bug/drug issue that will help you.

 

[DrNick2006]

There is no easy way to learn this because it varies based on several factors including local suceptability patterns, formulary contraints, institutional bias etc. What I suggest is learn common infection states and what organisms / groups of bugs need to be covered.

I recommend to buy a Sandford guide untill you know what your doing.

 

[EtOHWithdrawal]

To expand, you can always call your clinical pharmacist for advice... They can usually regurgitate antibiograms specific for your hospital.

 

[AsherAysh]

hey- I'm just a lowly MS-2 now, but I was a pharmacist. I was looking at these posts to see what sort of misery lies in future. Anyway, I know the pain of antibiotics. There is a Dr. Jeff Guy at Vanderbilt- I think he's a surgeon/critical care/burn sort of doctor. He has a great pod cast series on I-Tunes, including one on antibiotic selection. You could listen to it on your commute or whatever. It's free. Another resource that I like is the the Medical Letter Treatment Guidelines. They do a great bug/drug issue that will help you.

Hey, do you happen to know where to find those pod casts. I went on iTunes and didn't see it.

Thanks

 

[docB]

I recommend to buy a Sandford guide untill you know what your doing.

I agree with using a Sanford. The best way to learn what you're doing is to look up the system you're trying to treat (eg. urinary tract) and the section in the front will tell you what the most common bugs are and what drugs to use empirically. That right there will change a bad answer to a good answer on rounds. For example "Why did you give levofloxacin?" changes from the poor answer "Because that's what we always use for UTI." to the good answer "This hospitalized female patient is most likley to have an E. coli UTI which should respind to the levofloxacin and it will have better activity than a cephalosporin." It's not that they won't come back with some teaching points like "Yeah, but what about using Bactrim?" or the like but you'll have avoided looking stupid which is the main goal of residency.

 

[Doowai]

I recommend to buy a Sandford guide untill you know what your doing.

I heard ironically Sanford died from an ID from being prescribed the wrong ABX. Anyone know if this is true or urban legend?

 

[Winged Scapula]

I heard ironically Sanford died from an ID from being prescribed the wrong ABX. Anyone know if this is true or urban legend?

According to this, he died of complications of Lymphoma at the age of 68: http://news.acponline.org/journals/news/mar97/obit0397.htm

I suppose one of the complications could have been overwhelming sepsis untreated or mistreated.

 

[PharmD2MD]

Hey, do you happen to know where to find those pod casts. I went on iTunes and didn't see it.

Thanks

I found it by clicking the "browse" feature, then "science and medicine", then subcategory "medicine". There are a ton of medical podcasts. Scroll down to Surgery ICU Rounds by Jeffrey S. Guy. He's a good lecturer.

 

[Blade28]

I agree that you should also review Sanford, Johns Hopkins or consult the Pharm/ID folks at your hospital.

 

[andrea]

Excellent ideas. Much appreciated!

 

[AsherAysh]

I found it by clicking the "browse" feature, then "science and medicine", then subcategory "medicine". There are a ton of medical podcasts. Scroll down to Surgery ICU Rounds by Jeffrey S. Guy. He's a good lecturer.

Thanks! He sounds a bit like Jeff Goldblum.

 

[angel80]

See if your hospital publishes it's own antibiotic guide. We have one at our hospital that is published by our ID and pharmacy department. It is updated every 2-3 years and includes the major organisms seen in our institution, as well as our susceptibility patterns. For example, if you were suspicious about SBP in a patient, you would most likely use Ceftrioxone over Cipro because our gram negatives are more susceptible to 3rd generation cephalosporins than quinolones. It also only includes those drugs which we have on formulary. You can look up a certain topic, for example, health-care associatied pneumonia, and you get 2-3 possible first line regimens, as well as second-line regimens if a patient had specific allergies. Many hospitals I've been to have these types of guides available for their institution.

 

[Midwest Medic]

EMRA also publishes a VERY good antibiotic guide. You can get it here:http:///www.emra.org/Index.cfm?FuseAction=Page&PageID=1000945
This is a great guide that lists about every common type of infection, and gives about every option of antibiotics for them. Then it is up to you to figure out which drug you should give based on the patient and your local institution's resistance trends.