Page 21 - Christiana Care Focus April 2019

When should a patient with
a sinus infection be given
an antibiotic? When does a patient’s sore throat suggest
a bacterial, rather than viral, cause? Which antibiotic should be given to a septic patient who needs rapid resuscitation?
When emergency room physicians face questions like these, they need answers quickly, concisely and right the first time.
In 1991, the Emergency Medicine Residents’ Association (EMRA) published its first pocket-sized reference guide on the use of antibiotics in the emergency department
Sand put it in the hands of thousands of emergency medicine residents.
ince 2005, Christiana Care Associate Chief Academic Officer Brian Levine, M.D., has edited the book with the help of a changing
cast of emergency medicine residents.
In addition to getting its name on the cover of a widely used guidebook, Christiana Care’s authorship of these guides educates its residents in the finer points of antibiotic use and stewardship, ultimately benefiting patients here and elsewhere.
Christiana Care physicians also have developed two other EMRA guidebooks. Jeremy Berberian, M.D., created the EMRA EKG Guide, released in 2017, and Robert S. Hsu, M.D., is leading a team authoring a guide to treating orthopedic injuries in the emergency department.
Top seller
The antibiotic guide, which remains EMRA’s most popular publication, is given to each of the organization’s more than 16,000 members and is used around the globe.
It was this challenge of finding simplicity in the complex, combined with his long-time interest in pharmacology, that first led
Dr. Levine to pursue and earn the right
to edit the 12th edition of the antibiotic guidebook, released in 2007.
More than a decade later, the decision has echoed through the professional lives of hundreds of Christiana Care emergency medicine residents and medical students, and the health of countless patients.
Dr. Levine uses the guide as a learning opportunity for Christiana Care’s 60 or so emergency medicine residents. Working with Executive Assistant Sherrill Mullenix, he assigns chapters to each of them. Residents are responsible for looking through the literature to revise their own sections with the latest guidelines.
“This is a lesson with lasting value and unique rewards,” said Dr. Levine. “Our residents throughout their careers will see colleagues carrying around dog-eared, well- worn copies of the very antibiotic guide they edited.”
nfections are some of the most com- mon reasons patients come to emer- gency departments, and finding an
| Innovation Because the guide helps caregivers avoid
treatments their patients don’t need, many of its recommendations bear the logo of the Choosing Wisely initiative, which seeks to cut down on unnecessary care.
Concise, and easy to read
The guidebook is the result of hundreds
of decisions about what details are neces- sary and what would only add to the word count. The guide, for example, recommends considering antivirals if serious symptoms accompany Bell’s palsy, but trusts the clini- cian already knows what “serious” means. And the guide doesn’t bother describing what areas are endemic for Lyme disease — it figures providers already know that too.
Improvements through the years include those from Laura Quint, M.B.B.S., a chief resident in emergency medicine at Christiana
Care. She has a
background in medical textbooks at Oxford University
Press, and she improved the guide’s grammar, typography and design.
The result is a book that’s not only concise but easy on the eyes — organized and color coded by body system — with the antibiotic options and dosing for each condition.
EMRA hears appreciation echoed in the praises of its members, said Valerie Hunt, managing editor.
“Christiana Care’s model is to give you exactly what you need to know to care for your patient without getting bogged down,” she said. “It’s written in a way that everyone from a brand-new learner to an attending physician can pick it up and find relevant information quickly.” 
To prescribe or not to prescribe
I
effective antibiotic among scores of options isn’t as straightforward as it seems. There are side effects and drug interactions to consider, and patterns of resistance change constantly.
The guide also shines at telling caregivers when not to use antibiotics. Patients with a facial muscle weakness called Bell’s palsy only get antibiotics if they have a high likelihood of Lyme disease.
Similarly, antibiotics won’t help most patients with a sore throat or sinus infection, but some with underlying medical conditions may need them to avoid dangerous consequences.
Antibiotic stewardship is a major goal of the guide, which is careful to note when
an antibiotic isn’t appropriate. The digital version of the guide is updated as resistance patterns change.
Laura Quint, MBBS
The antibiotic guide remains EMRA’s most popular publication.
FOCUS • APRIL 2019 19