The ABCs of Choosing the Right AntiBacterial Agent 2E 2013 by Alan R. Hauser

vii PREFACE Which is more diffi cult: learning a large body of information or applying the newly learned information? Although the answer is debatable, it is clear that health care professionals must do both. Most health care training programs consist of an initial phase of classroom lectures and small group sessions in which the intricacies of cra- nial nerves, the Krebs cycle, and renal physiology are mastered. Following this phase, trainees suddenly are immersed in the real world of patients who present with com- plaints of a cough, a painful lower back, or a fever. As an infectious disease subspecial- ist, I have often seen this culture shock expressed as the blank look of a medical student when asked, “So, what antibiotic should we start this patient on?” Obviously, a basic understanding of the principles of pharmacology and microbiology is insuffi cient for most trainees when suddenly faced with the complexities of an infected patient. This book is meant to be a guide to antibiotics not only for students studying to be physicians, nurse practitioners, physician assistants, pharmacologists, or medical tech- nologists, but will also prove useful for residents, fellows, and practicing clinicians. It is designed to serve as a bridge between the book knowledge acquired during the initial phase of training and the refl exive prescribing habits of experienced practitioners. Just as the initial bewildering complexities of electrocardiograms and chest radiographs dis- appear when the fi rst principles underlying these tests are appreciated and understood, so too do the diffi culties of antibiotic selection. By supplying the rationale behind anti- biotic selection for many common bacterial pathogens and infectious disease presenta- tions, much of the memorization (and magic and mystery) that usually accompanies proper prescribing of antibiotics is eliminated. Where memorization is unavoidable, learning aids are presented that will make the process as painless as possible. This book can be easily read and comprehended in 1 or 2 weeks by a busy student or practitioner. As a result, it is not a comprehensive guide to the antibiotic metropolis but merely an outline of the major thoroughfares of antibiotic therapy so that readers can more easily fi ll in the residential streets and alleys as they gain experience. In terms of the war analogy used throughout the book, the emphasis is on strategy, not tactics. Thus, only commonly used antibiotics are mentioned, and some oversimplifi cation and omissions are unavoidable. It is hoped that the reader will be able to master the major concepts and rules so that with subsequent clinical exposure and practice, the nuances and exceptions to these rules may be assimilated. The scope of this volume is limited to antibacterial agents, arguably the most com- plex and frequently encountered antibiotics that must be mastered by health care prac- titioners. Future volumes will address antiviral, antifungal, and antiparasitic agents. The second edition of this book has been updated and expanded to include newer antibiotics that have become available during the past 3 years. In addition, several old- er antibiotics that have enjoyed renewed popularity (e.g., colistin and nitrofurantoin) are now also discussed. Emerging resistant organisms such as community-acquired methicillin-resistant Staphylococcus aureus and Klebsiella pneumoniae carbapenemase- producing bacteria have been incorporated. Likewise, sections have been updated to refl ect recent changes in treatment guidelines, such as those pertaining to Clostridium diffi cile colitis and urinary tract infections.