Primary Care Corner with Geoffrey Modest MD: Choosing wisely — infectious disease society recommendations

By: Dr. Geoffrey Modest

Will pass along the infectious disease society “choosing-wisely” recommendations for decreasing antibiotic use. Although none of these are new or surprising, data suggest that antibiotics are still being prescribed for these conditions unwisely….  (see here)

1. Don’t treat asymptomatic bacteruria with antibiotics. (except pregnant patients, those undergoing invasive urological surgery including prostate surgery, or those within 1 year of kidney or kidney pancreas transplant)
2. Avoid antibiotics for upper respiratory infections. most are viral. But one should treat group A strep and pertussis
3. Don’t use antibiotics for stasis dermatitis of lower extremities. Use leg elevation and compression. [in my experience, this can be a difficult call: stasis dermatitis can really look like cellulitis with bright red, well-demarcated erythema, though with less induration than cellulitis. And i would add that topical steroids do work quickly with stasis dermatitis]
4. Don’t test for clostridium difficile infection in the absence of diarrhea. Except if ileus from c. difficile is suspected. In general​, c. diff carriage should not be treated so shouldn’t be looked for
5. Don’t use prophylactic antibiotics for treatment of mitral valve prolapse as a means to prevent endocarditis.

So, just a reminder.