choosing wisely -- infectious disease society recommendations

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 http://www.choosingwisely.org/doctor-patient-lists/infectious-diseases-society-of-america/ )

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.

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