The new pocket antibiogram cards will soon be ready for everyone.
In the meantime, please read these main points and trends regarding infectious disease at Salem Health:
Infections due to multiple-drug resistant organisms, specifically carbapenem-resistant enterobacteriaceae, are becoming a big problem.
Meropenem susceptibility is now down to 89 percent for pseudomonas. This suggests that cefepime, Zosyn or any aminoglycoside are better choices for treatment of suspected or confirmed pseudomona infections.
Ciprofloxacin susceptibility is decreasing for many of the gram-negative species we see in the hospital, making it a poor empiric choice for many infection types.
Ciprofloxacin, aminoglycosides and Bactrim still have good coverage for Enterobacter and other multi-drug resistant organisms. Consider this before looking at one of the new combo drugs to treat complicated urinary tract infections. Newer combination agents approved for MDROs are restricted to infectious disease prescribing.
Aminoglycosides have excellent gram-negative rod coverage across the board – not useful as monotherapy in all infections – but I think we should address the concern of aminoglycoside usage. By the data shown in the most recent antibiogram, aminoglycosides are potentially some of our most useful agents.
Consider Bactrim and doxycycline to treat mild to moderate methicillin-resistant Staphylococcus aureus skin infections. These agents show better susceptibility than clindamycin.
Heavy use of cefazolin and cephalexin has led to cefazolin susceptibility decreases for gram-negative species.
Ampicillin is the drug of choice for enterococcus and group B streptococcal infections. Make sure to confirm if the patient has a true penicillin allergy before reaching for something else.