Damn antibiotics...

[StringBean]

These stupid antibiotics are really driving me crazy! I've been trying to get them down in my head for EVER and they just won't stick. I'm towards to end of my 3rd year and I can still only seem to remember the common ones used in the hospitals I've spent time in. If given a diagnosis and possible bug responsible for it... I'm sure I couldn't come up with the best antibiotic choice.

Anyone have any ideas/hints/tips to really get this *%&#$!@ memorized? Any help would be oh, so greatfully appreciated!

Thanks,
~Bean

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[doc05]

there's no reason to memorize abx. The Sanford guide exists for a reason. As does the ID consultant.

 

[Idiopathic]

I agree. I would understand the principles behind the classes, and pick up things as you go (i.e. rx for uncomplicated UTI, what do you give a penicillin-allergic px for strep throat, initial rx of CAP).

Use the books...your patients will thank you.

 

[Cpt.Hook Hamate]

there's no reason to memorize abx. The Sanford guide exists for a reason. As does the ID consultant.

Yes. The above quote is option number one. Keep consulting the Sanford guy and after so many times of seeing Penicillin is used to treat syphillis, you will get the picture.


Option #2 is Microbiology Made Ridiculously Simple

Option #3 is Microbiology Made Ridiculously Simple

Option #4 is Microbiology Made Ridiculously Simple

Option #5 is Microbiology Made Ridiculously Simple

 

[JudoKing01]

Bactrim for UTI, am I right? Please tell me I'm right.

 

[TruTrooper]

Bactrim for UTI, am I right? Please tell me I'm right.

I believe there has been increased concern about antibiotic resistance to Bactrim so now Ceftriaxone is the new first line, if I recall correctly but Bactrim is still used pretty often.

 

[AJM]

I believe there has been increased concern about antibiotic resistance to Bactrim so now Ceftriaxone is the new first line, if I recall correctly but Bactrim is still used pretty often.

Yikes - ceftriaxone for a simple UTI??? Talk about hitting the bug hard. FYI, ceftriaxone is a med that can only be given IV, and is not an antibiotic that we typically give for just a simple UTI. It does cover urine sources, so you can give it for a pt hospitalized with pyelonephritis -- but even then fluoroquinolones like cipro are considered better coverage.

Typical 1st-line therapy for UTI is cipro or bactrim. Nitrofurantoin or keflex are often used if patients have allergies or side effects. Bactrim use depends on what the resistance pattern of E coli is in your specific region of the country. Classically it is considered a 1st line agent, but because of the growing resistance of E coli, many physicians don't use it anymore. Most people usually just reach for the cipro.

 

[THP]

I asked my family pratice preceptor this very question and he gave me the Sanford guide. He also said that he likes to know 3 abx for each of the most common conditions and learn them very well.

 

[JudoKing01]

Sweeeeeeeet. I kick ass (for about 4 seconds).

 

[JudoKing01]

Is that a storm trooper on the can?

 

[TruTrooper]

Yikes - ceftriaxone for a simple UTI??? Talk about hitting the bug hard.

Where does he state that it is a "simple" UTI? I said in so many words that I wasn't sure. It has been a while since I had to put drugs in my A & P for a UTI but I do remember Bactrim not being prescribed much due to resistance issue but I do understand it is still used some. It really depends on the situation. Is the patient NPO? Does he already have IV access? Blah blah blah...

 

[TruTrooper]

Is that a storm trooper on the can?

Yes! Troopers' s**t stinks just like everyone elses...

 

[AJM]

Where does he state that it is a "simple" UTI? I said in so many words that I wasn't sure. It has been a while since I had to put drugs in my A & P for a UTI but I do remember Bactrim not being prescribed much due to resistance issue but I do understand it is still used some. It really depends on the situation. Is the patient NPO? Does he already have IV access? Blah blah blah...

Dude, when someone is talking about a UTI, the vast majority of the time they are talking about an uncomplicated (ie simple) UTI, which is an outpatient issue. Much less commonly are patients admitted for treatment of a complicated UTI or pyelo. Maybe you've only been exposed to patients with urosepsis in your inpatient rotations, but admitting a patient and giving them IV antibiotics is not the standard for most UTIs.

Please, let's not confuse the issue for these poor souls who are just trying to get the hang of basic antibiotic regimens. The 1st line therapy for both uncomplicated and complicated UTIs is still either cipro or bactrim. If you answer bactrim on exams you will be correct. However, if your area has a high resistance rate to bactrim, then you should use cipro instead. For pyelo, the first line therapy is still a fluoroquinolone -- you can choose to give it IV or PO depending if the patient is able to take in PO's. Cephalosporins can be used as well, but with them you don't get quite as good coverage of all the UTI bugs (but often close enough for government work...).

 

[AJM]

Yes! Troopers' s**t stinks just like everyone elses...

Oh yeah - and I like your trooper pic, too.

 

[TruTrooper]

Dude, when someone is talking about a UTI, the vast majority of the time they are talking about an uncomplicated (ie simple) UTI, which is an outpatient issue. Much less commonly are patients admitted for treatment of a complicated UTI or pyelo. Maybe you've only been exposed to patients with urosepsis in your inpatient rotations, but admitting a patient and giving them IV antibiotics is not the standard for most UTIs.

Please, let's not confuse the issue for these poor souls who are just trying to get the hang of basic antibiotic regimens. The 1st line therapy for both uncomplicated and complicated UTIs is still either cipro or bactrim. If you answer bactrim on exams you will be correct. However, if your area has a high resistance rate to bactrim, then you should use cipro instead. For pyelo, the first line therapy is still a fluoroquinolone -- you can choose to give it IV or PO depending if the patient is able to take in PO's. Cephalosporins can be used as well, but with them you don't get quite as good coverage of all the UTI bugs (but often close enough for government work...).

Dude, I wasn't trying to confuse the picture. My only point is what is always the case is the fact that you must look at the entire clinical picture. What if it is a NPO person? You certainly can't answer Bactrim or Cipro. This why they give you the long vignettes on the exam and not just the one line "what drug do you give for UTI?"

I did a infectious disease elective several months ago and recently finished my OB/GYN and I can honestly say that not once did we prescribe bactrim for a UTI although every book or exam tells you to do so. By the time we make it to 3rd year we all find out that what is the right answer on the exam is not necessarily what is mostly done clinically. And no I haven't been only exposed to people with urosepsis. I go to school in Detroit, baby, and I am exposed to a whole lot more than Urosepsis, I assure you. I just been exposed enough to know to look at the whole clinical picture before handing out a drug.

The fact of the matter is, that there is growing resistance to Bactrim so it is not prescribed as often. I don't know how else to put this but just do a medline search or something.

I am not telling you what to pick on an exam (although an exam that uses Cipro and Bactrim as separate answer choices would be entirely unfair and unlikely). I am tellling you what is happening to Bactrim. It is not the big bad drug it used to be just like many other antibiotics, after significant resistance is encountered, alternatives must be used. Forget your books right here for a minute and think about what is actually being used in your clinics. You are likely to see Cipro used more and Bactrim may not be the alternative.

Those "poor souls" will be okay.

 

[TruTrooper]

Oh yeah - and I like your trooper pic, too.

Thx. I got one I like better but it is a little too big to use as an avatar.

 

[AJM]

What if it is a NPO person? You certainly can't answer Bactrim or Cipro.

Fluoroquinolones can be given IV, so yes, the 1st line treatment for an NPO pt with a UTI would be IV cipro.

I did a infectious disease elective several months ago and recently finished my OB/GYN and I can honestly say that not once did we prescribe bactrim for a UTI although every book or exam tells you to do so.

1st - people don't consult ID for treatment for UTIs. They get ID consults when there are weird infections or unusual/resistent bugs. Of course you're not going to provide the 1st line treatment on ID because by the time ID is called the primary team is working their way down to the 3rd or 4th line treatments.
2nd - I honestly mean no disrespect to Ob/Gyn, but Ob/Gyn is not the service you should be learning take-home points about antibiotics from (unless the take-home points are which antibiotics are safe to give to pregnant women).

I really don't mean to beat a dead horse, but much of practicing medicine is about learning how to categorize your patient and knowing the standard treatment options for their disease. With respect to antibiotics, that means knowing 2-3 standard antibiotics used for 1st line therapy with each major type of infection. Now I agree that every patient is different, and that's when you have to use your clinical judgment. But in order to effectively use your judgment, you have to know what the standard is and go from there.

I'm not trying to argue with you about the growing resistance problems with Bactrim -- I agree on that -- I was just disagreeing as to what the other 1st line therapies were. But while we're still on the Bactrim subject, there are regions of the country that have a low enough resistance to Bactrim that they still use it as 1st line. In my area, though, the resistance is high enough that we usually don't choose it. But in my 3 years of internal medicine residency, I have definitely prescribed that antibiotic several times -- but usually because there are special situations such as the patient not being able to afford any other appropriate antibiotic, the presence of a highly resistant bug only sensitive to SMX, or the pt being allergic to everything else.

My advice: get a Sanford, or download the Johns Hopkins abx manual -- they have excellent recommendations for 1st and 2nd line abx therapies. Try to learn the mainstay treatments of the major infections.

 

[raptor5]

UTI or whatever else comes your way I say use Chloramphenicol w/ Trovafloxacin! It'll kill something!

 

[DOtobe]

Do an ID rotation, and you will become more familiar with the antibiotics used for different infections. (Although ID docs D/C more antibiotics than they start.) You'll see some cool infections (I saw an endocarditis due to enterococcus and an osteomyelitis due to some funky Candida species, just to name a few) and a ton of C. diff, but you'll learn a lot.

 

[SLUser11]

This thread could be half as long if TruTrooper had just said, "oops, I'm wrong!" instead of "Nuh-uh! What if the culture grows a bug resistant to everything but ceftriaxone? Then, it would be the best choice!"

FYI I'm pretty sure Rocephin can be given IM, and it IS used in the ER as first line for UTIs, especially with loose ladies probably carrying around some gonococcal fun.

FYI I am also a huge nerd for responding to this.....

 

[AJM]

This thread could be half as long if TruTrooper had just said, "oops, I'm wrong!" instead of "Nuh-uh! What if the culture grows a bug resistant to everything but ceftriaxone? Then, it would be the best choice!"

FYI I'm pretty sure Rocephin can be given IM, and it IS used in the ER as first line for UTIs, especially with loose ladies probably carrying around some gonococcal fun.

FYI I am also a huge nerd for responding to this.....

lol - you're right! I forgot about the IM option. I guess you could do that if you want to be mean to your patients... I've only given CTX IM to women with GC/Chlamydia infections, but maybe in other ED's they give it for UTIs... it's not a standard treatment regimen for outpatient treatment of a UTI, though, and it's not something most primary care clinics stock.

Okay, I'll stop being nerdy now...