Some thoughts to stimulate discussion!
- Make friends with your enemy (micro-organisms). Know a lot about The most important pathogens. Be systematic and critical about your knowledge and study. Access local research and expertise as much as possible. Contribute to research. Organism study proforma.
- Know your antibiotics and again, know a lot about The most important antimicrobials. Be systematic about your study- use multiple sources. Antimicrobial study proforma. Aminoglycoside and vancomycin dosing and administration require particular focus.
- Understand how to use microbiology to the best advantage. The aim is to know what you are treating and direct the therapy appropriately. Visit the lab where you are working and learn from the pathologist or microbiology scientist. Collaborate with them in the interest of the patient.
- Understand how antimicrobial susceptibility is measured and the limitations of lab testing. Understand that the ‘in vivo’ susceptibility test does not always get it right!
- Understand antimicrobial resistance and access local patterns of resistance from Pubmed (cumulative antibiograms) – this is your guide to empirical therapy in sepsis. If/when local antibiotic guidelines are established, follow these as they should have factored in local resistance patterns. Be skeptical about foreign (and local) guidelines and potential conflicts of interest in those who formulate them.
- Remember that to avoid Tragedy of the Commons, we all need to behave differently as prescribers to preserve this precious resource. Always make your antibiotic therapy A I M E D.
- Learn about Antibiotic stewardship programs. The ARHAI Antimicrobial prescribing and stewardship competencies are a good place to start. Be a systems engineer – patients need effective care and medicos are well-placed to speak up for patient interests and improve systems of care.