The Sanford Guide To Antimicrobial Therapy 2016

The typical photosensitizing drug is of low molecular weight (200-500 dalton) with a planar, tricyclic, or polycyclic chemical configuration; it often has heteroatoms in its structure. Photoactivation results in generation of free radicals and singlet oxygen species. More than 300 drugs (mainly antimicrobials, NSAIDs, and cardiovascular agents) have been characterized as photosensitizers. A photosensitivity reaction generally resolves with drug discontinuation and sun avoidance, although patients who are unable to stop the offending drug will require topical steroids and protective physical measures to lessen symptoms. The Sanford Guide maintains a list* of possible and probable antimicrobial offenders (Clin Dermatol 34:571, 2016).

The Sanford Guide to Antimicrobial Therapy 2016

This book presents the fundamentals of infectious diseases and discusses how to assess patients to assure that the proper antimicrobial therapy is selected and monitored, all within the scope of a multidisciplinary antibiotic stewardship program.

The purpose is to provide pharmacists, particularly those who have not specialized in infectious disease, the basics of assessment of patients with infections, as well as treatment plans, drug therapy monitoring, and how to be a part of a formal antibiotic stewardship program. This is especially important as this spring, the Infectious Diseases Society of America drafted new antibiotic stewardship guidelines that specifically name pharmacists as key members of these programs.

We assessed the appropriateness of antibiotic therapy for choice of antibiotic drug (antibiotic indication), dosage and route of administration. Criteria for assessing the appropriateness of indication were physician adherence to guideline-recommended antimicrobials from either Vietnam Ministry of Health15 or the mobile app-based Sanford Guide (accessed in September 2018).16 The appropriateness of dosage and route of administration was assessed based on three databases: Lexicomp Lexi-Drugs Multinational,17 Micromedex Drug Reference,18 and the Sanford Guide to Antimicrobial Therapy.19 Overall appropriate antibiotic therapy was defined as patients receiving appropriate antibiotic indication, dosage and route of administration.

Several pathways may explain our findings. The choice of empirical antimicrobial regimens in patients with sepsis and septic shock is complex, and several factors must be assessed at each medical centre and for each patient, while the emergency of initiating antimicrobial therapy made it more challenging to determine the appropriate regimen.2,5 Moreover, clinicians should consider the distribution of pathogens and their susceptibility patterns in the institution where the regimen is administered.2,5 Apart from choosing appropriate antibiotics, the selection of the optimal antibiotic regimens includes dosing, duration of therapy and route of administration. Our study revealed that the most common reasons for administering inappropriate dosage were related to adjustment for renal impairment and the necessity of higher doses of some agents in sepsis. 041b061a72