There are now several smartphone apps available for anti-microbial prescribing. Some of these can even be programmed with your institution’s local guidelines. Locally, we use the “Microguide app”
However as far as I am aware, the apps currently related to antibiotic prescribing do not intake/process patient information. (Please correct me if I am wrong on this.)
But that is the next step…
Two key questions related to good antibiotic stewardship are as follows:
- Based on the clinical findings, does this patient actually need an antibiotic?
- If so, which antibiotic would be best ?
Humans are generally good at writing antibiotic guidelines. However they are not so good at following them. That’s because lots of other things get in the way, such as emotion, past experience, fatigue, and the desire to do everything possible to help the patient in front of them.
It will only be another few years before apps designed to answer these questions will be available. They might be rudimentary to start off with, but it won’t be long before they become sophisticated and will be every bit as competent as physicians are at making most of the routine decisions. (Think about chess computers…)
I am sure these guidelines will require regulatory approval (FDA, etc.) and it will be interesting to see how these bodies approach such apps.
In 2050, I will be 77, and coming up to the (revised) retirement age. In 2050, clinical decision making apps in all branches of medicine will be commonplace, I am sure of it. Computers are (at present) unemotional, and therefore very well placed to perform this job of deciding who exactly needs an antibiotic, and if so, which one.
However I suspect such apps will be in everyday use long before 2050…
Michael
Hmmm……….apps and medicine. They do have a place (albeit I am yet to give them one) in medicine, but the GP in me knows the relational aspect of prescribing antibiotics to a patient. Sometimes the choice of antibiotic (and certainly a decision NOT to prescribe) has to be negotiated: the doctor often has to get the patient (and their family) onside
As it happens, two separate and unrelated patients over the past 7 days both of whom were moderately unwell with bronchitis, I have switched antibiotics based on sputum culture results and sensitivities. Interestingly, despite the culture and sensitivity results confirming a bacterial pathogen and indicating resistance, both patients reported to me when I phoned up to explain I wanted to change the antibiotic “But, doctor, I am definitely quite a lot better already with the antibiotic I’m on”
In the community, unlike a desperately ill hospital patient, most treatment decisions involve an element of, if not negotiation, patient agreement. I guess an App could help me as the GP negotiate this with them……….. It would have saved me a friendly phone call to you today, Michael. But then what about the relational aspects of General Practice and the Community Lab Microbiologists?
Thanks for your comments Geraldine. I see this all the time, patients getting better despite being on the “wrong” antibiotic. We tend to forget that in the pre-antibiotic era many people still got better by themselves. This will not have changed since the inception of antibiotics. The correlation between in- vitro susceptibility and in-vivo response is a fascinating one.
And then yes of course there is the relational or human aspect of the decision, between the clinician and the patient, and the clinician and the microbiologist. This is key in trust building. It is usually the clinicians I don’t hear from which worry me much more than the ones that I do…
Michael
Dear Michael, I received my book today and I am absolutely loving it! I love your style of writing and the “personal stuff” just feels like a conversation, feels very practical and engaging. I am hoping to find employment as a microbiology technician at the tender age of 43!. My feeling is its never too late! . Thanks again for your amazing book and website
Best Regards June Anne McKnight
Glad you are enjoying it June! Good luck with getting a job in microbiology. If you show you are passionate about it, that is half the battle. Don’t worry, you are only 43, the same age as me, and you are young yet! Best wishes, Michael