First, no list of choices can be perfect. However the CMS list is configured to cover not just the suspected source, but to broadly cover in the event that the guess the clinician is making is only partly or, in fact, not correct in the first instance.
This broadness is justified by the incredible mortality risk of guessing incorrectly. The cited concern that "Flagyl must be given with 2 other antibiotics...could lead to a patient getting unnecessary antibiotics" is less harmful than a death from a poor guess or even informed guess that's just wrong. Unnecessary antibiotics can be peeled off once certainty develops, but you can't go back in time the other way and add antibiotics you inadvertently did not give... A similar rationale exists for uti. Cipro may be a good drug if you are sure you are treating uti alone, but what if there's something else? In sepsis we cover gram positive and gram negative at first blush all the time then reduce coverage later. IDSA signed onto the 2012 sepsis guidelines stating just that -- initial coverage should be broad due to mortality risk and tapered once source is definitive and principles of antibiotic stewardship should be applied. > On Dec 30, 2015, at 3:31 PM, Cobb, Amy L. <[email protected]> wrote: > > One concern (intra-abd source) is that Flagyl must be given with 2 other > antibiotics if given which could lead to a patient getting unnecessary > antibiotics. _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
