Common Questions: Infectious Diseases in the Community Setting (Common Questions in ID)

Effective multidisciplinary medical care in the community setting relies heavily on the way information is communicated to physicians, mid-level providers, and their patients. Most physicians and other providers will consult online resources, with several excellent tools available for answering the usual questions relating to infectious diseases, like which antibiotics to use for certain infections, appropriate doses, and so on. Many resources also provide illustrative cases which are very helpful. But they often lack more detailed answers to practical questions commonly raised by community physicians in a form that is relatable and easily retrievable (yet still thorough and well-referenced). Many excellent and typically more nuanced questions related to infectious diseases are posed every day in medical practice, and their answers often include information not easily found in standard reference materials…because why else would providers be asking? A few examples include: "What antibiotics can I really use for someone with a penicillin allergy?""Should I continue antibiotics in my patient who is still in intensive care but with negative cultures?" "Is there ever any benefit to clearing bacteria from the urinary tract?" "Does my patient with a prosthetic joint infection need to take antibiotics for the rest of her life?" "Since we rarely get cultures to guide antibiotic choices for skin infections, how do we know what to use?"Answers to these and many other infectious disease-related questions in the community setting rely on knowledge of factors that impact both individual patients and patient communities. This book is an attempt to provide answers conveying the relative importance of these factors using an evidence-based approach. Since the best interest of the patient is the most important factor, we often ask “What is the price of being wrong?” The answer to this question guides antibiotic recommendations in many cases and involves elements of antibiotic “stewardship” less familiar to many physicians and providers. These elements include knowledge of local antibiotic resistance patterns, anticipated progression of disease for specific infections, potential drug-drug interactions and toxicities, and comparative outcome data generated by clinical trials. All of these items are important to discuss with patients so they understand why we are making our recommendations. And there are actually good published data to help us answer many of these questions! Bringing evidence-based answers to nuanced questions posed directly by patients and their physicians remains the primary goal of this book. It is not meant to replace or serve as “cliff notes” for national and international guidelines, review articles, or other resources related to clinical infectious diseases. Rather it is meant to provide patient-centered and physician-friendly answers to empower communication with patients, careful consideration of diagnostic testing and antibiotic use, and an understanding of where recommendations are coming from. Sections in the manual will be updated over time as new information is published and validated in the literature. Topics addressed reflect their commonality within the medical communities of Western North Carolina where I practice. Therefore, this first edition is not an exhaustive trip through every corner of the infectious disease universe. But even common travel-related and oncologic infections are addressed to the extent that they have arisen in my early community practice experience. No matter what your practice environment, we hope this book will help you and your patients!