The Sanford Guide To Antimicrobial Therapy 2023

So You Need The Sanford Guide

I run into this question constantly in hospital ID rounds and pharmacy consults. Everyone knows Sanford exists but half the people who use it don't actually know how to use it efficiently. Let me save you some time. The Sanford Guide is a yearly updated compendium of antimicrobial drug information. It covers dosing, spectrum, resistance patterns, and special populations. The 2023 edition came out in spring of that year, same pattern as always. It's published by Sanford MediText and available through their app, their website, and print copy. Many hospitals subscribe institutionally. If you're a clinician or student, check whether your hospital or school already has a license before buying anything.

The Sanford Guide To Antimicrobial Therapy 2023

Here's the practical thing nobody tells you about the 2023 version. It introduced updated resistance data from the SENTRY and ANST projects with a heavier emphasis on CRE and VRE trends. The dosing sections got refreshed for the newer agents like cefiderocol and the ceftazidime-avibactam dosing adjustments for renal impairment. If you're prescribing for an ICU patient with CRAB, the 2023 edition has more specific combination therapy suggestions than the 2022 one. That's worth looking at directly. The app and web version are where most of us actually work. The print book is fine for reference but it's heavy, it doesn't update, and the index is harder to navigate than the search function in the digital version. I use the app on my phone and the web dashboard on the desktop. The app lets you look up a bug or a drug, check interaction tables, and pull dose calculators. The web version is better for printing consult notes and for running broader searches across multiple organisms at once. One thing that trips people up: Sanford doesn't update continuously between editions. If you bought the 2023 guide in late 2023 and something major happened in early 2024, that information isn't in there. You'd need the 2024 edition or another source for that. This matters for emerging resistance scenarios. Don't treat the 2023 edition as a living document after its publication date. Pair it with local antibiograms and CDC guidelines when you're dealing with something time-sensitive.

I ran into a specific problem last year with this. A patient came in with polymicrobial intra-abdominal infection and the culture grew an ESBL-producing E. coli that was also resistant to meropenem at the high end of the breakpoint range. The 2023 Sanford entry for meropenem listed the standard dosing and the carbapenem-sparing options but didn't have a dedicated section for high-MIC carbapenem-resistant Enterobacterales in intra-abdominal sources. I ended up cross-referencing the Sanford guidance on ceftazidime-avibactam with the EUCAST updated breakpoints from June 2023 and the clinical practice guidelines from IDSA on ASB and intra-abdominal infections. The workaround was to use Sanford for the baseline drug information and then pull the specific resistance breakpoint tables from the CLSI M100 2023 document and the FDA labeling for the newer beta-lactam beta-lactamase inhibitor combinations. It added about twenty minutes to the consult but prevented a dosing error that could've been serious. Here's a counter-intuitive point that beginners miss. Sanford's resistance tables are general. They're based on aggregated data and they vary by region and hospital type. Your hospital's antibiogram will tell you more about what's actually circulating in your unit than anything in the guide. I've seen residents get tripped up because they saw a drug listed as "active" in Sanford and then prescribed it for a patient whose local isolate was resistant. Always check your own antibiogram first. Use Sanford for dosing, interactions, and spectrum overview, not as the sole authority on local resistance patterns. Another nuance. The pediatric dosing sections in Sanford are solid but they're based on standard weight-based calculations. For extreme body weights, neonates, and patients on CRRT, the numbers can drift. I've seen pharmacists catch errors where Sanford listed a flat dose and the clinical team didn't adjust for the patient's actual lean body mass or the augmented renal clearance. The guide gives you the framework. It doesn't replace clinical judgment for the edge cases.

If you're looking to download or access the 2023 edition, the official source is the Sanford website at sanfordguide.com. They offer a subscription-based app and a web portal. There's no legal free download of the full guide. You'll see pirated copies floating around forums and file-sharing sites. Don't use them. The data might be outdated, the OCR could be messed up, and using unverified versions is a liability issue in any clinical setting. If cost is a concern, many institutions offer student licenses or free trials. Check with your library or your hospital's pharmacy department. The guide is organized by organism, by drug, and by infection type. The organism section is the most commonly used. You pick the bug, it tells you the drugs, the doses, the resistance notes. The drug section works the other way around. The infection section is useful when you know the clinical scenario but haven't identified the organism yet. I find the search function faster than browsing the tabs. Type in the drug name or the bug and it pulls up the relevant entries across all sections. One limitation worth stating bluntly. Sanford doesn't cover everything. It focuses on antibacterial, antifungal, and antiviral agents. It's thin on anti-parasitic coverage. If you're dealing with a travel medicine case or an infectious disease consult involving something like strongyloides or babesia, you're better off with the CDC Yellow Book or UpToDate. Also, Sanford's coverage of dose adjustments for hemodialysis versus CRRT versus peritoneal dialysis can be superficial. The app has a renal dosing calculator but it's not always granular enough for complex critically ill patients. For those situations, I use the guide for the base info and then check the specific drug's prescribing information or call pharmacy specifically for the dosing.

The 2023 edition also doesn't have the latest data on post-pandemic antimicrobial use trends. If you're researching stewardship impact or looking at resistance shifts from 2020 through 2022, the guide will lag behind the primary literature by a year or so. Pair it with recent papers from Clinical Infectious Diseases or the Journal of Antimicrobial Chemotherapy for the full picture. In practice, I keep the Sanford app open on my phone during rounds. I pull up the organism for every positive culture, check the dosing for any renal adjustments, and verify interactions before writing orders. It takes maybe two minutes per patient. That's about as useful as it gets. Anything more complicated than that usually means the case needs a deeper look beyond what any single reference can provide.