Digging through old files for data, I ran across this talk, developed in 2005. Yes, I actually gave this talk on several occasions staring in '06. For those who have wondered, yes, I've always been like this--it's congenital, not acquired, dementia with psychotic features. Yes, I began treating osteo orally in 2005, and considered the myth of IV only for osteo busted. Numerous colleagues told me I was insane and practicing below the standard of care medicine. To whit, I cop to the former, but history has vindicated me on the latter.

I tried to do that in the Principles of Anti-Infective Therapy chapter in the Mandell text. 10 sequential principles which, if followed, help optimize abx usage.

1) Before picking abx, start with an accurate differential diagnosis
2) Only give abx when they will improve outcome

https://twitter.com/BJegorovic/status/1607170481303568384

3) When 1 and 2 are met (DDx includes infection caused by bacteria & pts outcome can be improved by abx), give empiric Tx targeting bacteria causing the diseases in the differential
4) In critically ill patients, use a lower threshold for starting empiric Tx

Soon to wrap up another go around on ID consult service, and some observations to share. Some may be controversial, but things humming along and the team running like a well-oiled machine, thought I'd begin a dialogue. 2 major observations, with detail for both. 1) The old trope of fellow/resident/student lumbering along with a 10 min formal pt presentation followed by 30 minutes of attending pontification is passe and needs to be retired. That's not medicine in 21st century, and I don't even think it's good for learning.