For antibiotic management, refer to UCSF Infectious Diseases Management Program guidelines (available on AgileMD for UCSF), the Johns Hopkins Guide to Antibiotics (http://hopkins-abxguide.org/), the Infectious Diseases Society of America Guidelines (http://www.idsociety.org/Content.aspx?id=9088), or the Sanford Guide to Antimicrobial Therapy

Other high-yield resources and guidelines:

• HIV InSite: Knowledge Base and SFGH ward 86 Management Guidelines (http://hivinsite.ucsf.edu/)
• CDC guidelines on Opportunistic Infection Prophylaxis and Treatment (https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/0)
• CDC STD Treatment Guidelines (http://www.cdc.gov/std/treatment/2010/)

General Principles in the Management of Infectious Diseases

• Broad spectrum antibiotics are appropriate for empiric therapy but narrow your antibiotics when you have identified a pathogen
• Have a low threshold to start empiric antibiotic therapy in immunocompromised patients; they may not mount a fever or leukocytosis and may show only limited localizing signs and symptoms of infection (e.g. minimal abdominal pain in the setting of a perforation)
• Differentiate community-acquired and healthcare-associated infections -- the pathogens (and your empiric therapy) may be different
• Know your local antibiogram to help determine empiric therapy; use the UCSF IDMP website
• Obtain cultures (blood, urine, CSF, etc..) before starting antibiotics, when possible; whenever ordering a urine culture, always order a UA with micro as well.
• Try not to obtain cultures from only a central line, except to compare to your peripheral cultures.
• Give some time for your antibiotic therapy to work, clinical improvement is not immediate and can take days in certain disease states
• Use resources above plus your infectious diseases physicians and infectious diseases pharmacists to provide the best care for your patients

Key words: antibiotics