Many junior doctors in the inpatient setting may find the management of infectious diseases challenging, particularly knowing which bacteria are associated with different clinical infections, as well as what antibiotic regimen should be directed.
Different infections, from newborn meningitis, pneumonia, to Helicobacter pylori or Clostridium difficile infection should all be managed differently. Each infection requires different antibiotic therapy, which also varies in duration.
So, how to know what drug covers which bacteria and how long the therapy should last? Are you confident and competent at prescribing nephrotoxic drugs, such as Vancomycin or Gentamicin? How you should deal with antibiotic resistance?
Questions like these actuated junior doctors at the Southampton University Hospitals in the UK to request some sort of guide for complicated management of infectious diseases that would also be available for point-of-care use on their smartphones.
Upon their requests, in 2011, a team of doctors from Southampton General Hospital, transformed their "Pocket Guide" for new residents, pharmacists, and medical students, and turned it into the MicroGuide app for the iOS and Android devices that should provide point-of-care assistance with the management of infections and antibiotic therapy.
Initially, the app was developed for pharmacists, enabling them to create, edit and publish antimicrobial guidelines to their mobile devices so they always stay updated with the latest recommendations.
The app's biggest success was a sustained reduction in prescribing of high-risk broad-spectrum antibiotics from 40% to 28%, coinciding with a fall in Clostridium difficile infections from 60 a month to less than 10.
The initial app's objective has since been expanded, and consequently Horizon Strategic Partners developed a new version of MicroGuide last year (2015) that now includes a wide range of guidelines and publications on infections and antibiotic management from various sources.
Before start using the app, users are required to provide name, email and credentials, including their profession, practice, grade and organization.
Users can choose from a list of organizations, mostly from UK, Ireland and New Zealand, which actually provide guidelines for this app. If your organization isn't listed you can contact the app developers for more information.
The MicroGuide app opens with a home screen featuring the same list of organization allowing you to choose their guidelines (one or more). Tapping on organization will open new screen with a guidelines from that organization. Most of these guidelines are aimed toward adults, while some organizations provide pediatric guideline as well. The guidelines you've chosen will be listed in My Guides section that is visible once you tap on Menu the button.
Guidelines have similar structure, including brief explanation of current version, tables with useful contact numbers within the organization, as well as medical-oriented information, such as body systems, surgical prophylaxis, sepsis, antibiotic stewardship, etc.
Tapping on Body Systems features infections associated with various organ systems, from central nervous system to gastrointestinal and cardiovascular system. While the app covers a lot of infections, you'll probably notice the absence of STI, or fungal or tick-borne infections.
Opening any of the systems features most common infections associated with that system, but which also depends on the organizations and their guidelines. For example, if you've chosen central nervous system, the Wellington Hospital guide features only four infections, including community-acquired meningitis, along with contact prophylaxis, viral encephalitis and ventriculitis.
The guide from London Bridge Hospital, on the other hand, expands the information, by separating bacterial from viral meningitis, and by adding ophthalmic infections.
As you could see, while most of these guides provide similar information, it may vary depending on the local practice of the organization that issues the guidelines. Most users would use the app according to the guidelines provided by their own institution.
Opening Bacterial Meningitis page in London Bridge Hospital guide will advise you to start treatment as soon as blood cultures have been taken (probably all other guides would). Users will also get concise information, from general considerations, contacts numbers to treatment steps.
The page provides recommendations on first line of treatment, considerations and alternatives if there's a history of Penicillin allergy, as well as recommendations to cover Listeria meningitis if the patient is pregnant, immunocompromised or aged over 50 years. All recommendations also include dosage.
This guide also recommends how long the therapy should last depending on the type of bacteria, as well as what specimens should be taken from the patient suspected of having meningitis.
All drugs listed are interlinked and open new pages with additional information about the dosage, particularly in renal impairment, as well as about administering, which basically just links to Electronic Medicines Compendium and Grapevine databases, or advise users to contact their pharmacies.
MicroGuide app also features detailed guides to sepsis and surgical prophylaxis, as well as healthcare-associated infections, i.e. MRSA and Clostridium difficile infections, which are both explained in great detail in similar format as the rest of the guides.
Each page can be bookmarked and accessed later via Bookmarks menu. Also, healthcare providers can add notes, by simply copying and pasting the parts of the text.
Interesting part of this app are dosing guidelines for aminoglycoside and glycopeptide antibiotics, such as Vancomycin and Gentamicin, which also include creatinine clearance and nomogram calculators, very useful for the decision-making support.
Except for these calculators, as well as occasional graphs and tables, the guides in the MicroGuide app mostly rely on text. There is a problem with formatting, so some parts of the text are not shown properly, as well as the tables that are not adapted to the mobile view and often 'escape' the screen.
However, this isn't a big deal, because the app's true value is the comprehensive information on the management of clinical infections and antibiotic therapy, both often too complicated and requiring thoughtful guidelines, which MicroGuide app indeed provides.
Benefit: This app is useful not only to junior doctors, but also to more experienced clinicians and pharmacist dealing with complicated management of infections and antibiotics.