Remembering which antibiotics cover what?

[mackie]

---

Members do not see this ad.

Any recommendations for reviewing this stuff--Books, articles, etc? I feel at a loss, especially with all these resistant organisms these days. I have to look up EVERYTHING! How do you remember?

 

[glorytaker]

I think it's pretty OK unless you're doind ID. I get doctors from all sorts of fields (ER, IM, etc) who ask me if I have a Sanford's on me. The only ones who don't ever ask are the GI, OB and Surgeons.

 

[powermd]

Any recommendations for reviewing this stuff--Books, articles, etc? I feel at a loss, especially with all these resistant organisms these days. I have to look up EVERYTHING! How do you remember?

Sanford's, ID fellow curbside consults, pharmacy, and, of course, repetition. What you acutually use may be influenced by what deals your hospital has struck with pharm companies, shortages, community resistance profiles, individual bug sensitivities, etc..

 

[retroviridae]

Sanford's, ID fellow curbside consults, pharmacy, and, of course, repetition. What you acutually use may be influenced by what deals your hospital has struck with pharm companies, shortages, community resistance profiles, individual bug sensitivities, etc..

I only know how to use 3 abx: zosyn, Vanc, and flagyl for the c diff.

 

[ramonaquimby]

bump 🙂

 

[Mumpu]

Like most things in clinical medicine, practical knowledge does not necessarily come from reviewing books. You'll find that most people think in terms of disease coverage, not pathogen coverage (i.e. what antibiotic is good for uncomplicated UTI vs. what covers E. coli and S. saprophyticus). You pretty much have to do an ID month (always a good idea no matter what medical field you are going into) if you want to learn the nuances of antibiotic use, pick up cool tricks (continuous infusion vanc), and get experience using things you wouldn't normally touch (carbipenems, colistin, aminoglycosides, etc.).

Wow, I managed a post about antibiotics without starting a flame war with another specialty. :]

 

[tum]

I think Mumpu's comments are important here. For wards, think in disease patterns, not in antibiotic coverage patterns.

That is to say, think of what is usually prescribed empirically for a certain disease. Specific coverage can be adjusted once further studies come back. There are a few books at any good medical bookstore that deal with this more 'clinical' thinking pattern. For me, Sabatine's does the trick.

 

[Hernandez]

I agree with Tum & mumpu. I'm trying to learn most common bugs for dz processes and then try to pick the meds from there. Standford guides have a couple of pages which are great for coverage to help pick out an abx if you wish to cover a couple of bugs, and then there are a few resources that I've seen such as Gideon's which are good to help determine the tissue penetration and half life.

 

[ChildNeuro]

Like most things in clinical medicine, practical knowledge does not necessarily come from reviewing books. You'll find that most people think in terms of disease coverage, not pathogen coverage (i.e. what antibiotic is good for uncomplicated UTI vs. what covers E. coli and S. saprophyticus). You pretty much have to do an ID month (always a good idea no matter what medical field you are going into) if you want to learn the nuances of antibiotic use, pick up cool tricks (continuous infusion vanc), and get experience using things you wouldn't normally touch (carbipenems, colistin, aminoglycosides, etc.).

Wow, I managed a post about antibiotics without starting a flame war with another specialty. :]

There are standard antibiotics that you can assign based on what you think the disease process is, i.e. hospital acquired pneumoniae oh yeah I heard that I could use cipro for this. I think that using such an approach is a very bad idea, because, if you prescribe the antibiotic then you are responsible for changing the antibiotic if the patient doesn't improve in the expected time. Always, always, always, ask yourself, "What is the bug?" The answer may be many different organisms, so you do empiric coverage, but say you get a cultures & sensitivity results back, then you need to target that bug. You must must know also where the gaps in coverage are for whatever you are prescribing, i.e. the cephalosporins don't cover enterococcus, MRSA or Listeria. If you don't know what the antibiotic was targeting in the begining, then you won't know how to change your therapy. You can always consult ID, but this takes time, time when your patient should be getting better. Antibiotics are an important therapeutic modality that has saved many lives when used properly, you really need to have an excellent grasp on what the likely organisms are for common and not so common medical conditions if you are a general internist, this may include talking to your hospital ID department to figure out what the most common bacterial cause of disease X is in the hospital you are at. Most attendings think about the likely organisms when told a disease process, i.e. UTI makes your neurons light up so you think gram negative automatically, . . . If you prescribe an antibiotic and you don't know the likely organism but just afixed an antibiotic name to a disease then you very easily could get your patient into trouble