Infectious disease hospital practice

Figure A.2 H. Lambert, and F. W. Edmund, Slide Atlas of Infectious Disease, Gower Medical Publishing (1982). Figure A.3 modified from G. S. Rachelefsky, Hospital Practice, Nov. 15,1995.

Since the 1980s, the specialty area of infectious diseases within pharmacy practice has evolved into a distinct discipline that is directed at providing optimum antimicrobial therapy to patients. The pharmacist is uniquely qualified to apply therapeutic, pharmacokinetic, and pharmacodynamic principles to antimicrobial therapy. These skills serve to complement rather than compete with the roles of infectious diseases physicians. Infectious diseases pharmacists are employed in private and teaching hospitals, clinics, academia, and industry. Literature that document the positive impact of the infectious diseases pharmacist on patient outcomes is now being published. 

Pharmaceutical care of the hospitalized patient with infection is the most traditional role for infectious diseases pharmacists. Numerous opportunities for proactive interventions in antimicrobial selection, dosing, route of administration, and monitoring of patients with changing clinical status make this a popular practice setting for many individuals. 

Infectious diseases pharmacists typically practice in a hospital setting that allows them to devote all their time to managing antimicrobial therapy. All aspects of infectious diseases pharmacotherapy, including interventions on antimicrobial selection, antimicrobial dosing, and intravenous-to-oral conversion are the responsibility of the infectious diseases pharmacist. In addition, the pharmacist is usually responsible for analyzing new antimicrobials for formulary inclusion, medication use evaluations, and antimicrobial restriction or therapeutic interchange policies. 

Although the salary for many hospital pharmacists who practice exclusively in the area of infectious diseases comes from the hospital in which they practice, a substantial number are cofunded by hospitals and schools of pharmacy or medicine. 

Most infectious diseases pharmacists who practice in a hospital setting round with an infectious diseases consult service. This service usually consists of an infectious diseases physician, an infectious diseases medical fellow, medical students, an infectious diseases pharmacist, and (possibly) pharmacy students, residents, or fellows. Patients are usually identified through infectious diseases consults. The pharmacist usually acts to optimize the antimicrobial regimen by adjusting antibiotic doses... 

Another common practice model for hospital-based pharmacists is a one-on-one collaboration between an infectious diseases pharmacist and an infectious diseases physician. Under this model, the infectious diseases physician is generally responsible for standard infectious diseases consults. The pharmacist acts as an extension of the infectious diseases physician s clinical practice clinical practice, rather than competition or duplication. The pharmacist identifies patients in whom antimicrobial therapy is suboptimal (i.e., wrong drug, wrong dose, questionable indication, potential for IV-to-oral conversion). After conferral with the infectious diseases physician, an intervention is recommended or implemented. These interventions usually follow predefined criteria established by the Pharmacy and Therapeutics Committee. 

Under a third practice model in the hospital setting, infectious diseases physicians and pharmacists conduct separate services the physician handles infectious di-... 

Pennington JE. Nosocomial respiratory infections. In Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas and Bennett s Principles and Practice of Infectious Disease. 4th ed. New York Churchill Livingstone, 1995 2599-2616. Schleupner CJ, Cobb DK. A study of the etiologies and treatment of nosocomial pneumonia in a community-based teaching hospital. Infect Control Hosp Epidemiol 1992 13 515-525. 

---