What are the best antimicrobial stewardship resources for your daily practice? In this article a pharmacist trained in antimicrobial stewardship and infectious diseases attempts to answer this question by identifying some of the most useful guidelines, apps, documents, and websites available.
Authored by: Timothy P. Gauthier, Pharm.D., BCPS-AQ ID
[Last updated: 22 February 2018]
Participating in antimicrobial stewardship activities means making decisions that attempt to ensure the safe and rational use of antibacterial, antiviral, antifungal, and antiparasitic drugs. As defenders of our precious antimicrobial arsenal, antibiotic stewards serve an important role in conserving these life-saving therapies for future generations.
The concept of antimicrobial stewardship is easy to endorse, because everyone wants antibiotics to keep working for when someone gets an infection. On the day-to-day level however, being a good antibiotic steward can be challenging, because let’s face it, work is busy, every case is unique, and finding reliable information can be difficult.
So where can people turn to for quick and reliable resources that will help them be better antibiotic stewards? This article seeks to help answer that question. Hopefully you are able to identify at least one or two resources here that you had not previously known about.
Here are my 5 top antimicrobial stewardship resources for daily practice…
1. Centers for Disease Control and Prevention
The CDC is amazing when it comes to supporting antimicrobial stewardship activities.
CDC offers a robust collection of materials relevant to persons practicing in the field of infectious diseases and antimicrobial stewardship. From print materials for patients to easy to use practice-based apps to oseltamivir dosing recommendations, CDC has a ton of helpful resources. Their materials are free to access, easy to navigate, and reliable.
Here are a few of their web pages that are particularly useful…
- 2015 STD Treatment Guidelines
- Traveler’s Health
- Vaccines and Immunizations Recommendations
- Influenza Antiviral Medications: Summary for Clinicians
- Pre-Exposure Prophylaxis for HIV (PrEP)
- Antibiotic Prescribing and Use
- U.S. Antibiotic Awareness Week
- CDC Mobile Applications Listing
2. Clinical Practice Guidelines from the Infectious Diseases Society of America
The IDSA clinical practice guidelines home page can be found here. The documents can be searched by year, status, organ system, or organism.
IDSA offers a large number of practice guidelines free to access. These documents are extremely helpful for answering questions about the diagnosis and treatment of various common infectious diseases.
The IDSA guidelines can be a bit bulky and are not quick reads, but if you can find time to familiarize yourself with the ones most relevant to your practice, they may become one of your best go-to resources.
Tip: when using the IDSA guidelines (and other resources) use the CTRL+F command for “find” to search for key words within documents.
3. Guidelines from AIDSinfo & Quick References from the Southeast AETC
As a component of the U.S. Department of Health and Human Services, AIDSinfo provides a range of helpful and reliable content. Their clinical guidelines menu can be found here. Their app is available in Apple’s App Store here.
Some of the key guidelines they provide are…
- Adult & Adolescent Antiretroviral Therapy
- Pediatric Antiretroviral Therapy
- Adult & Adolescent Opportunistic Infection Management
- Pediatric Opportunistic Infection Management
Another HIV-centric resource that can be extremely helpful are the quick reference materials provided by the Southeast AIDS Education & Training Center Program (AETC). The full list is of quick reference guides is available here. Two of the most useful quick reference documents are…
- Pocket Card: Antiretroviral Therapy In Adults & Adolescents
- Pocket Card: Opportunistic Infections in Adults & Adolescents with HIV Infection
4. Uptodate, Lexicomp, and Micromedex
Many healthcare practitioners are using these resources on a daily basis, so it makes sense to also use them for the purposes of antimicrobial stewardship. The down side for these three resources are that none of them are free, although your employer or school may have a subscription you can get access through.
For reliable information on the diagnosis and management of different infectious processes, UpToDate is one of the best resources you will find. It has materials regularly updated by content experts. It also pulls drug information data from Lexicomp, which is a reliable clinical drug information program, so most of the drug-specific information is quite good.
There is not a great difference between Lexicomp and Micromedex. They are both excellent clinical drug information programs. Many pharmacists use at least one of these tools on a daily basis. They are helpful for identifying pharmacokinetic/pharmacodynamic properties, dose adjustments, adverse effects, black box warnings, precautions, and much more.
5. Open-access institutional antimicrobial stewardship websites
This one is a bit more specific to infectious diseases and antimicrobial stewardship pharmacists, but these are some really awesome resources. Multiple institutional antimicrobial stewardship programs now provide open-access content on the internet to help us avoid totally reinventing the wheel.
Two of my favorite resources are available here…
A list of institutional antimicrobial stewardship program websites is available here…
- Barnes Jewish
- CHI Franciscan
- Children’s Hospital of Philadelphia
- Cleveland Clinic
- Columbia University
- Jackson Memorial Health System
- Johns Hopkins
- Louisville
- Maine Medical Center
- Nebraska Medicine
- Ochsner Health
- Palmetto Health
- Sinai Health System / U. Health Network
- SUNY Downstate Medical Center
- Louis Children’s Hospital
- Stanford
- UCLA
- UCSF
- University of Kentucky
- University of Miami
- University of PA Health System
- University of Rhode Island
- University of Wisconsin
- Wake Forest
*Bonus Resources*
After posting this article to social media, a few people chimed in with some of their favorite resources, which were not listed. They offered some great additional resources, so it seemed reasonable to add them to the list. Here are some bonus antimicrobial stewardship resources, courtesy of some infectious diseases & antimicrobial stewardship enthusiasts on Twitter…
- Sanford Guide (Dr. Crane, @ASP_PharmD)
- Johns Hopkins Antibiotics Guide (@BrianOfBPharm)
- An Infectious Disease Compendium: A Persiflagers Guide (Dr. Branam, @BranamDon)
- Comprehensive Guidance for Antibiotic Dosing in Obese Adults (Dr. Ha, @DHpharmd)
These are more for stewardship folks to keep in mind or check out on the day-to-day…
- Joint Commission Standards on Antimicrobial Stewardship (Dr. Ha, @DHpharmd)
- National Quality Partners Playbook: Antibiotic Stewardship in Acute Care (Dr. Stevens, @Dr_Mike_Stevens)
- Updates from @CIDRAP-ASP on Twitter (Dr. Goff, @IDpharmd)
Closing Comments
Hopefully you have identified a few new tools to use in practice or maybe this helped to solidify that you are using some of the best tools currently available.
There are a lot of really awesome resources out there for use today and coming in the future, so keep an eye out for new good stuff that can help us all be better stewards of our antimicrobial drugs.
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