Sep 25, 2019
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What is a good guide for learning antibiotics? I want to learn an intuitive way to prescribe antibiotics for different conditions, not just memorize. (I'm a student) What are your suggestions?
 

smq123

John William Waterhouse
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As this would be a topic for ALL incoming interns (not just in family medicine), moving to general residency forum.
 
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cj_cregg

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Learn what types of bugs cause which infections, and then learn what antibiotics cover what types of bugs. What do anaerobes infect and what antibiotics cover them, for example? What drugs cover things like pseudomonas or MRSA, and which patients/infections should you think about covering those bugs in?

Also have to think about local resistance and susceptibility patterns - one city might have a really high rate of UTIs resistant to one drug, and another might have high rates of resistance to another drug. Often, hospitals will have an antibiogram or recommendations for empiric treatment based on susceptibility patterns in the local area.

You'll get there with practice!
 
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FrkyBgStok

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it just takes time but learn the common drugs. the reality is that I prescribe a handful of antibiotics on a regular basis and there is a ridiculous number of antibiotics that I, nor anyone I know, have every prescribed. so learn that ones that are used. for example: clindamycin generally covers gram + and anaerobes, but no gram -. cephalosporins go up in gram - coverage generally speaking with every generation at the cost of gram positive. CNS penetration also goes up but they are inherently resistant to enterococcus. these ones cover MRSA, these ones cover pseudomonas. ampicillin covers this, augmentin adds this, Unasyn adds that, and zosyn covers that. meropenum is used when all isn't enough.

it is way to difficult to try to learn all of the stuff and it makes zero clinical sense in the real world. I have never ordered a first generation cephalosporin outside of cefazolin and cephalexin. I only order ceftriaxone as a third generation but sometimes order ceftaz in certain situations only. and cefepime when I want ceftiaxone plus pseudomanas. The list goes on. there is just no utility for a non ID doc to say "oh this rare bug is best covered by this specific antibiotic."

and probably the single biggest reason is that is how my hospital does it. a different hospital will do different antibiotics. so learn the major groups and coverages in a broad sense but as a student, understand that putting too much effort in the wrong thing is going to be a huge waste of time.
 
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cj_cregg

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Thank you! It just seems really intimidating
You'll get there! You have plenty of time to learn. You'll start to see patterns pretty quickly and eventually fill in knowledge and understanding of why that antibiotic is the right one. If you're ever unsure...use your local hospital's antibiogram/empiric treatment guide (mine has one for both inpatient and outpatient management!) and/or uptodate.
 

neoexile

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Apr 30, 2016
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What is a good guide for learning antibiotics? I want to learn an intuitive way to prescribe antibiotics for different conditions, not just memorize. (I'm a student) What are your suggestions?
Personally, I start with Rocephin for everything in the hospital. But if you want some guide for common things:

Pneumonia: Rocephin/zithromax; if severe, use Vancomycin/Cefepime and Zithromax

UTI: Rocephin usually

GI related: Zosyn or Rocephin/Flagyl

Skin and Soft Tissue Infections: Rocephin (if purulent: I&D and give Vancomycin)


This being said, no substitute for history or physical and thinking through a situation before jumping to an antibiotic regimen automatically
 

jurassicpark

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Oct 19, 2018
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It's unfortunately just going to be memorization and constant familiarization. I've yet to see any catchy tune or way to nail them, except constant exposure and use.
 
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