Choosing antibiotics

I learned the following: (1) increasing MRSA rates may indicate a shift from oxacillin to other antibiotics like clindamycin in the future for empiric treatment of skin and soft tissue infections, (2) clinicians must utilize local (hospital) antibiotic resistance patterns for Enterobacteriaceae, and (3) the good news that the older drugs remain as good options for infections with streptococcus pneumoniae and gonococcus, and cholera.

2012 Summary of DOH Antimicrobial Resistance Pattern

When more is NOT necessarily better for patients

Choosing Wisely, an initiative of the American Board of Internal Medicine, says NO. Here are the links for 5 tests or treatments (and the situations) that patients should question.

For adult patients (internal medicine)

For older adults (geriatric medicine)

For patients with arthritis and other rheumatic disease (rheumatology)

Clean dish strategy for treatment of gout

Allopurinol may be discontinued after five years of treatment as long as certain conditions are met. These are: (1) allopurinol is given for at least 5 years after resolution of tophi OR for 5 years in those without tophi, (2) serum uric acid levels are maintained at less than 6mg/dL during allopurinol treatment and (3) serum uric acid levels are maintained at less than 7mg/dL after withdrawal of allopurinol.

 Fernando Perez-Ruiz, MD, PhD, from Hospital Universitario Cruces in Vizcaya, Spain, and colleagues tested the hypothesis that a less stringent target is necessary for long-term treatment of gout once urate crystal dissolution is achieved.
 

http://onlinelibrary.wiley.com/doi/10.1002/art.30649/abstract