by: Alexander Chamessian, MS2
Antibiotics find their way into nearly every area of medicine. Accordingly, there is no shortage of resources that healthcare providers consult when it comes to understanding and prescribing antibiotics.
Add to this large body of tools a new app for the iPad called Antibiotics Manual by Spearhead Global Inc. This app is a collection of 188 flashcards, with each card detailing a particular antimicrobial. It is sold for $24.99 with a 50% educational discount available. The content comes from two infectious disease physicians from Temple University School of Medicine.
The general architecture of the app consists of a two-panel screen.
On the right side, there is the flashcard. Initially, all one sees is a white card with the generic and proprietary name of a drug. By clicking the “Flip” button at the bottom of the card, all the information pertaining to a particular drug is revealed. On the left is a navigation bar consisting of ‘decks’ with cards organized alphabetically as well as a proficiency score for each deck. There are also tabs for containing bookmarked and all cards and a toolbar with search, share and index functions. The left panel remains unchanged as you navigate through different cards. All the action is on the right.
Before I get into what I liked and didn’t like, I want to consider what the purpose of this app is and what audience it is intended to reach. Based on the features and layout of this app, it seems to me that Antibiotics Manual is trying to achieve two goals.
On the one hand, it is a searchable, fairly detailed reference resource that clinicians can consult when making treatment decisions. On the other hand, it is a learning tool by virtue of the flashcard format and simple grading system. Accordingly, both students and seasoned clinicians can benefit from this app.
I think the best component of this app is its content. Overall, I found the information on each card to be thorough, clear and well organized. Each card has different sections. They are:
- Basic Characteristics: Mechanism of Action, Mechanism of Resistance, Metabolic Route.
- FDA-Approved Indications
- Side effects/toxicity
- Drug Interactions/Food Interactions
- Special Populations
- The Art of Antimicrobial Therapy
Compared to other popular drug apps such as Lexicomp and Epocrates, I found the basic characteristics section to be much more detailed. One often gets ‘one-liners’ when it comes to descriptions of mechanism of action, mechanism of resistance and metabolism. But not here. This app provides ample pharmacodynamic information, which I welcome. The other sections are comparable to most other apps and references in terms of breadth.
One exception I found was dosing. Although the dosing information in this Antibiotics Manual is fairly extensive, epocrates and lexicomp do offer more dosing regimens for specific diseases and patient populations. A particularly nice standout feature was the “Art of Antimicrobial Therapy” section.
This is the last section in a card and it contains clinical pearls relevant to each drug. I found this section to be very useful when considering a particular drug as part of a treatment plan both because its substance and its style. Most of the card’s information is in blocks of text. In this last section, however, the clinical pearls are high-yield bullet points that one can quickly scan.
There are some things I would have liked to have seen but didn’t. When thinking about antibiotics, one often wants to look up a clinical disease or specific organism and find the appropriate drug. Many references offer this ability. For whatever reason, the authors of Antibiotic Manual decided not to offer such a capability. Admittedly, the app description states:
“This app does not recommend individual drugs for specific organisms or clinical syndromes; rather, it is a reference for the clinician to consult once the decision to use a particular antimicrobial has already been made.”
But why not? One of the roles of this app is to be a teaching tool. If it were not, there wouldn’t be a need for proficiency scores and flashcard format. So why not make this reference even more useful to the learner by allowing them to go from disease or bug to drug? The lack of this ability diminishes the utility of this app in my mind.
Overall, the user interface for Antibiotic Manual is clean, simple and intuitive. The navigation bar on the left is simple to use. I found the card index view to be the most useful as it allowed me to sift through any card in the whole deck. There is a search function that makes finding specific information within cards quick and easy.
The card information is well organized, with each section having a color banner and icon that tells you what category of content you’re looking at. The large font of the text makes reading easy. Side effects are distinguished by dark, black box-like borders, which called my eye to that section quickly.
I didn’t much like the fact that the content was written mostly in block text. When I want to find information quickly, I generally appreciate lists, such as a list of side effects or indications. This app puts everything in prose, such that you have to sift through the content to find what you want. I don’t think I’m alone in this preference.
Antibiotics manual definitely gets credit for creativity with some of the features it includes. Nothing is left untouched by social media these days, with antibiotics being no exception. If you so choose, this app allows you to share your bugs and drugs learning via Facebook or Twitter.
I tried this feature out expecting to share some nugget of info about an antibiotic with my friends, but I was sad to see that what was shared on Facebook and Twitter was my proficiency score for one of the decks. People share a lot of dumb stuff by social media, so posting my antibiotic card study stats isn’t the worst offense ever, but I wonder, who really cares? I have no desire to blast my friends’ newsfeed with meaningless proficiency scores.
In addition to these social media tools, there is also a handy voice notes and annotation feature. They function well and are useful for capturing ideas, questions or ancillary material. There is also a bookmark function that always you to tag your favorite or most used antibiotic cards.
Lastly, I want to comment on the utility of this app as a learning tool. Flashcards are most useful when they ask you to recall one or a few pieces of information. Testing yourself shows you where you stand in terms of your knowledge base, and the act of recalling helps implant the information firmly in mind. While this app styles the information as ‘flashcards’ that is really a misnomer.
There is too much information per card for them to be useful in assessing what you know. When I click the ‘I know it’ button for a card, does that mean I know all the facts for a drug? Not at all. Thus, the proficiency score I give myself is nearly meaningless. This is not a huge problem. The content of this app is still good, but as a learning and drilling tool it fails. The authors might have done better to avoid the flashcard format all together and just focus on the information. I only mention this so that medical students and others don’t buy this app expecting flashcards that they can use to quiz themselves. That is not what this app is for, despite its format.
Antibiotics Manual is a well-organized, attractive, and intuitive app that contains thorough information for 188 antimicrobial drugs. The content is comparable to that of other antibiotic and drug references, with some parts being outstanding. The lack of organism- and disease-specific antibiotic categorization diminishes this app’s usefulness. The user interface of this app is simple and clean. There are some additional features such as Facebook and Twitter posting capability and voice notes that might appeal to some users.
Although written in flashcard format, this app is not recommended for students who want a resource to use for study and self-assessment. Overall, this app is nicely done, but it is not as comprehensive as many of the other drug resources available for iPad and it doesn’t offer anything so remarkably unique or useful that warrants spending $24.99.