Zosyn

Previous articles in JFP have reviewed the medical uses of handheld computers (1) and freeware for Palm Operating System (OS) devices. (2) This review adds 2 infectious disease guides to the freeware list that were not available at the time the previous review was written.

The Johns Hopkins antibiotic guide

The Johns Hopkins University Antibiotic Guide (ABX Guide) requires 959K memory on Palm OS devices. ABX Guide is also available for PocketPCs such as the Compaq Ipaq and Hewlett-Packard Jornada.

ABX Guide can be easily downloaded at no charge after registration at the Web site, http://www.hopkins-abxguide.org/. The download places an icon on the PC desktop; the icon permits the user to update the software. Installation to the PocketPC is somewhat convoluted; the program can be installed only to the internal memory.

The opening screen of ABX Guide presents 3 choices: Diagnosis, Pathogen, and Antibiotic. Tapping Diagnosis on the touch-sensitive screen produces a list of 16 categories, listed alphabetically, including Bone/Joint, CNS, and Travel/Tropical (Figure 1). Selecting 1 of these sections produces a list of available topics within that. section. For example, the 15 choices in the Dermatology section range alphabetically from Acne to Tinea Versicolor. Selecting Tinea Versicolor opens the Treatment screen, on which topical treatment regimens for tinea versicolor are described.

[FIGURE 1 OMITTED]

Menus at the bottom of the screen allow users to switch within the Treatment section to a description of systemic therapies or to change from Treatment to Diagnostic Criteria, Common Pathogens, Important Points, Author Opinion, or Author Information (Figure W1 *). These sections often include a considerable amount of information and expert guidance. Important Points generally includes differential diagnostic considerations. Under Author Opinion, the user can usually, find a comparison of treatment options, including cost and toxicity. Further, for many diagnoses the Treatment section includes "general management," in which nonpharmacologic therapy is outlined; for example, "Instruct the patient not to touch the lesions and to wash hands frequently." These additional sections and their diagnostic and therapeutic detail are a distinguishing feature of ABX Guide. Because ABX Guide defaults to the most commonly accessed information (treatment), and because the path to the other information is logical and quick, this additional information is available without inhibiting ease of use.

One can also search by Pathogen, but it includes only 13 bacteria, 4 fungi, 4 parasites, 3 viruses, and 3 other organisms. The third option from the opening screen, Antibiotic, is subdivided into categories: Antibacterial, Antifungal, and so on. Selecting 1 of these produces an extensive corresponding drug list by generic name. Selecting any drug allows the user to access dosing information (including renal insufficiency dosing), class, indications, adverse reactions, drug interactions, forms, pregnancy risk, and comments, which typically include the antibiotic's spectrum of activity. Users can toggle between FDA-approved indications and indications "referenced within this guide." Curiously, in the Antibiotic/ Antiviral section, anti-herpes simplex virus (HSV) drugs are listed without therapy duration and with dosing intervals (eg, q8h) rather than dosing frequency (eg, tid). For example, famciclovir is listed as "500 mg po q8h (for zoster); 125 mg q12h (HSV)." When the user obtains this information via the Pathogen section, ABX Guide provides duration of therapy and dosing in terms of frequency.

ePocrates qID

The program ePocrates qID (qID) is freely downloadable after registration at http://www.epocrates. com/. This software requires 430K memory. The user can update to the latest version by deleting the old version and replacing it with the update. Currently available only for Palm OS devices, qID provides the same options as ABX Guide but uses different terminology (Figure 2).

[FIGURE 2 OMITTED]

The software opens on a By Location screen, which includes 13 anatomic locations. Selecting an anatomic location produces a list of relevant infections. For almost every listing, users can tap on the drug name and be transported to ePocrates' companion qRx drug database program for more detailed information about the drug itself, including brand names. (2) The Back button from qRx returns the user to qID.

In By Location, sequentially selecting Systemic, then Fever, Acute, and finally Tick, Flea, Lice Exposure results in a recommendation for empiric therapy with doxycycline. The Other Info for this screen includes a note that reads, in part: "... need to empirically tx human monocytotropic ehrlichiosis and human Guide's granulocytotropic ehrlichiosis which have nonspecific sx." (I was unable to find any reference to ehrlichiosis in ABX Guide.) In general, the Other Info section is very brief, in contrast to ABX Guide's wealth of information on everything from diagnostic criteria and differential diagnosis to the author's specific expert recommendations and caveats.

From the opening By Location screen, users can change to the By Bug or By Drug screens via a drop-down menu (Figure 2). The By Bug screen is an extensive alphabetic list of organisms, each followed by a category code (eg, GNR = gram-negative rod, V = virus) that can be decoded by being tapped upon. Selecting Trichomonas vaginalis produces a list of illnesses that may be associated with it. Clicking on Vaginitis produces a list of therapeutic options. More detailed information about a specific drug is available via the link to qRx.

The By Drug section is an extensive list of antipathogenic agents, each followed by a classification code, decodable by being tapped upon (Figure W2 *). In the By Drug section, dosing for drugs for HSV/VZV includes duration; dosing is listed in the preferred frequency terms. The By Drug section lists only generic names. Determining brand name and renal dosing recommendations requires bridging to qRx.

Comparing the Programs

The Table compares retrievals from the 2 programs for a few illustrative examples. Both programs contain a wealth of information. For PocketPC users, ABX Guide will be adequate. For Palm users, qID seems to have greater breadth, including childhood infections; ABX Guide has somewhat less breadth but considerably greater depth.

Each program has some features that the other does not. For example, qID has better information on therapy of candidal vaginitis, but I could find nothing on endocarditis prophylaxis. Neither program contains a global search feature. Both rely on generic names (no searching for Tequin or Zosyn, for example, in either reference).

At the outset of this review, I thought it would be easy to pick a winner, but it wasn't. Both programs are useful and complementary. I would recommend searching ABX Guide first, then qID when either the answer is not found or a double check is desired.

* For this figure, see the JFP Web site, www.jfponline.com.

REFERENCES

(1.) Ebell M, Rovner D. Information in the palm of your hand. J Fam Pract 2000; 49:243-51.

(2.) Fox GN. Freeware for the Palm operating system. J Fam Pract 2001; 50:807-13.

COPYRIGHT 2002 Appleton & Lange
COPYRIGHT 2002 Gale Group