Timely & relevant article! To fight resistance and C. difficile colitis, we must stop screening for UTIs in people without UTI symptoms, but we also need to use the right drugs for UTIs. Quinolone effectiveness is 50/50 in many areas due to years of overuse (moxifloxacin, fyi, has NEVER been good for UTIs). The alternatives happen to be CHEAPER (& possibly FREE at Publix, Walmart, etc): Nitrofurantoin, trimeth-sulfa are back in the running for empiric use, having been on the back burner for some time due to quinolone use; of the other class options, beta lactams, minocycline, and clarithromycin get the best levels in urine and cover most pathogens. It’s probably best not to choose a single “workhorse” antibiotic for that one patient with recurrent UTI; check a culture and susceptibilities & mix it up to keep bacteria guessing.
A few edits were made to Pearls 4.0, after an astute clinician pointed them out. (Reader feedback is much appreciated, it’s a one-doc show!)
1. KEEPS mnemonic for lactose-fermenting Gram negative bacilli – The letter P corrected from Proteus (which is NOT a lactose-fermenter!) to Providencia.
2. The Youtube link to Mr. Whipple expired! Replaced it with a photo. Perhaps if I’m ambitious or retire, I’ll figure out how to embed a video. :}
3. Fusobacterium was mentioned as one of the anaerobic Gram positive bacilli in discussion of clindamycin spectrum of coverage. It’s most certainly a Gram-negative bacillus.
Thanks to readers for keeping it real!
Updated Gompf’s ID Pearls 4.0 with COLOR image gallery, accessible via the homepage link, as well as the Gompf’s ID Pearls menu link.
I’m not sure how long the homepage link to Gompf’s ID Pearls has been broken, but I think it happened when I tweaked the document a few weeks ago. Terribly sorry for the inconvenience , & hope the Pearls continue to be helpful to you.
Happy & Prosperous New Year!
A couple of new pearls added!
Find out what that insect is at identifyUS.com, where they’ll IDMYBUG. Cool 🙂
[I have no financial or other relationship with this website or service. I just get asked about bugs all the time!]
Great infographic from MPHOnline.com on Zika Virus.
The “Don’t Miss Tickborne Diseases” handout in the Teaching & Tools menu has been updated with new photos and a correction. Download it now!