One of the most frequently used benefits to my EMRA (Emergency Medicine Residents’ Association) membership is the always handy, EMRA Antibiotic guide (which they sell on their website for $25.95).

It is often the only thing on me besides a stethoscope and my pen while I’m working an ED shift. Its pocket size, common sense organization (color coded pages by alphabetized organ systems) and ease of use make it a trusted reference of physicians both in and out of Emergency Medicine.

As small as the pocket guide is however (96, 4” x 6” pages), the idea of having an iPhone version and eliminating one more thing from my pockets excites me. Add in search functionality, and I figured we had a keeper. Not only that, but the fact that the iPhone app costs 10 dollars less than the physical text (available for 15.99 from the App Store) made this an app we had to check out.

Follow along to find out what we liked, what we didn’t, and if this should be an addition to your app library as well.

Organization & Navigation

When the app first opens, you’re greeted by a 1 second cover shot of the physical book, and then taken back to whichever screen you were at last (versus Epocrates & Medscape apps, which load you back to their “main” screens). This “default view” is customizable in the settings. The meat of the application is searching for appropriate antibiotics, and here you have choice of by organ system, diagnosis, or organism (selectable from a static menu bar at the bottom). There’s also a limited search function in each section.

The Good, The Bad, And The Ugly

Honestly, I tend to think of most of the iPhone reference apps in two categories. Some are great works of programming, aesthetically pleasing and intuitively navigated and well integrated, and feel as though they were built from the ground up to be an application. Others feel more like a port of a written reference, with text content simply scanned in or imported. Unfortunately, this app feels more like the latter. It is still a great useful reference, but doesn’t flow as fluid as even flipping the pages of the book.

A good example of this is the search function. Similar to other iPhone apps, when presented with a list, if you scroll the top downwards you find a “search” box. Unfortunately, this search box will only search the list you’re currently at. If you’re at the “Organ System” search screen and type in anything besides the names of the 9 organ systems they have listed, your results will be empty (above). Similarly, you get a different set of results depending on which tab you’re on, for the same search. If I search “HIV” under diagnosis, I get a list of co-diagnoses and pearls, however if I search under organism, I get the “sexual assault prophylaxis” topic. The only place that incorporates all of the results is a separate “search” function, hidden under the “more” tab. Unfortunately even this “search” function is limited to only headings (in the organ, diagnosis & organism sections). So a search of “MRSA” returns nothing, even though it’s mentioned under separate topics (for example, a search of cellulitis informs you that “facial erysipelas in adult must be treated empirically for MRSA (vancomycin) until in vitro susceptibilities available.”). Similarly, even though the application is an antibiotic guide, you can’t “search” antibiotic names!
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The other major lacking feature (that’s included in the back cover of the paperback version) is the antibiogram, a chart cross referencing antibiotics and pathogens with susceptibility. It really is priceless, especially when checking to see if the one antibiotic you want to use will cover two different organisms you’re trying to treat. While it doesn’t take into account local resistances, and I wouldn’t have even realized it was missing from the application had I not had the written version to compare it to, it is a feature we’d love to see added in the future. We may be able to do without it if antibiotics were searchable from somewhere in the app, but even if that functionality were added, we’d still appreciate the antibiogram.

The other missing feature from the app (included in the text) is the appendix, including information on drug reactions, pregnancy classes and metabolism routes.

The Verdict

A great reference packed with information and pearls, however unfortunately handicapped by its navigational tools. If you’ve used the pocket guide in the past, you’ll enjoy the familiarity (most of the entries are verbatim), but it may take some getting used to to find what you’re looking for, and you may reach for it occasionally and be disappointed that something isn’t there (the appendix, or antibiogram). In fact, the only thing the app has that the paper version doesn’t is that occasionally (once so far) they will update it with useful information, such as a section on H1N1 pearls.
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So should you buy it? If you can do without the antibiogram, and want to eliminate something from your pockets, I still recommend this application. It’s not as well polished or thorough as a larger app such as Epocrates and Medscape, but it does do what the book does exceptionally well: gives you an antibiotic from a trusted source for a disease or infectious organism. And 9 times out of 10, that’s all I’m looking for. Save the 10 bucks (from the paper version) and the weight of something extra in your pocket, and stick with the app.

Let us know in the comments section if this app treats what’s bugging you.