Right Drug at the Right Time: A Clinician’s Dilemma

A 75 year old male patient presents to the ER with signs of sepsis with no obvious focus of infection. The emergency physician needs to manage a likely infection along with supportive therapy. Let’s take a sneak peek into what goes on in her/his mind…

Stage 1: Well, old man with severe infection, I probably should be straight away starting with antibiotics. But ,what if the infection is viral in origin? I will be unnecessarily exposing the patient to the risk of adverse drug reactions and side effects including potential renal damage. And then there is an increasing threat of antimicrobial resistance and the need for judicious use of antibiotics. While I know I should not be prescribing antibiotics inappropriately, what options do I have?
Let’s do a rapid diagnostic test, if it comes positive for viral infections I can avoid antibiotics.But , what if the entire panel is negative?? Also I need to prescribe now. Am I justified in waiting for RDT? Perhaps no. Let me prescribe an empirical antibiotic now, I can always course correct later.

Stage 2: Antibiotics, which one to choose? Wish I had some clue to the possible bug, could have given a targeted drug then. What if I choose a narrow spectrum drug and totally miss hitting the target? I will probably lose the patient then.
Let me just refer to hospital antibiotic policy, that should be available in the order forms in the EHR.
They want me to give at least two drugs at one time and the drugs they are telling me were found to be resistant in the last 3 cases that I treated. Not even sure when were these guidelines updated.

Stage 3 : What was the most prevalent organism in the bloodstream infections in our hospital again? There was some hospital antibiogram circulated a few months back. Where would I find it now when I need it ? But even if I have it in my hand it’s so broad and generalized that it won’t give me any clue on what to use in this patient.
Wish someone could just tell me the “right drug” for this patient so that I could give him the best chance with least harm.

Thousands of front line clinicians across the globe struggle every day with the choice of right antibiotics at the right time for the patient. With only cohort level data and highly generalized treatment guidelines to support  their decisions, they have to take the heavy cognitive load of triangulating the multiple factors ranging from patient’s clinical parameters, hospital’s bug distribution patterns, antibiotic policies, drug related factors and growing fear of AMR before coming to a decision. With all this going on in their minds, no wonder 30% of antibiotics prescribed in the US currently are inappropriate and the need for Anti- Microbial Stewardship is huge.

In the current scenario of rapidly changing susceptibility patterns and ever increasing AMR, the time has come to look for a highly intelligent data based software solution available as a handy tool at the point of care. Something that makes use of artificial intelligence (AI) to reduce the clinician’s cognitive load. A system that not only gives patient level guidance but also updates itself automatically with each new bacterial culture flowing into the system. It should also be easy to use and easy to integrate into the current EMR systems and workflows and able to help the clinician choose the right drug empirically for better patient outcomes.

At Circle of Life, a highly competent team of data scientists and technocrats has built “ZEVAC” an AI based antimicrobial stewardship tool that perfectly answers a clinician’s dilemma and provides real time inputs for a proactive action to combat antimicrobial resistance . To know more about ZEVAC visit www.mycol.in

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