Antibiotics

All credit to some incredible doctor / medical student who put this together at UCSF! I have been using this since medical school to help me choose antibiotics in the ED. I promise, once you understand the method to the madness (& use it a few times!) it will click...

How to use:

(1) The large box is broken down into 4 quadrants 

• Top Left (RED section) = GRAM POSITIVES (e.g. skin stuff, strep/staph)

• Top Right (YELLOW section) = ATYPICALS  (e.g. Chlamydia pneumoniae)

• Bottom Left (BLUE section) = ANAEROBES (e.g. belly bugs!)

• Bottom Right (GREEN section) = GRAM NEGATIVES (e.g. E.coli)

(2) Two of the quadrants are further subdivided to include the "BIG BAD BUGS" within that category:

• Top Left "L" (RED section) = MRSA!!!

• Bottom Right "L" (GREEN section) = PSEUDOMONAS!!!

(3) Each "baby" box represents an antibiotic (see name under box), and the quadrant that is colored in is what that Abx covers!

(4) For example: "I have a really sick patient that has a fever, I don't exactly know the source, I need broad coverage, but I am fairly certain it is not the belly..."

• Vancomycin (Total RED quadrant colored in, including the "L" = Covers gram+, including MRSA

• Cefepime (Total GREEN quadrant colored in, including the "L" (also some gram+) = Covers gram -, including pseudomonas 

• Note, we did NOT use Zosyn (Pip/Tazo). Why? We did not need anaerobe (BLUE) coverage because we really were not worried about the belly. So we went broad, but not too broad.

• Maybe their CXR looks hazy all over... Add Azithromycin (Total YELLOW quadrant) for atypical coverage.

• This is a great way to be clever with choosing appropriate coverage in the ED. But, whenever in doubt, ask your friendly, neighborhood pharmacist or ID doc for help. They are the experts!