Foggy Bottom Lantern: Double coverage and pseudomonas, part I

Musings of a medical resident about the personal and professional challenges of residency and the experience of delivering health care on the urban front lines of our American system.

Location: Washington, United States

I'm a hospitalist physician, newly out of residency, working in the Pacific Northwest. My wife and I are expecting a son in March, who figures to play a central role in my future writing. Other than starting a family, my interests include tango, literature, evolution, science, classical music, Alaska, and Scandinavia.

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Friday, September 01, 2006

Double coverage and pseudomonas, part I

Enough of this fluff, it’s time for a little meat. Here’s a clinical problem I experienced as an intern last year: the pharmacist called because my patient with a leg ulcer was growing out pseudomonas, and she was concerned that the patient was only on single coverage with zosyn.
“The pseudomonas is sensitive to zosyn, though, right?” I asked.
“Yes,” she confirmed.
“So why would we want to double cover?”
“Well, usually it’s recommended to double cover against pseudomonas so it won’t develop resistance.”
“Hmm, I’m not sure that makes sense to me – I thought we only double covered empirically until we found out the sensitivities – let me talk with my team and get back to you.”

So who was right? Discussion to follow. . .