(02) Appropriate Antibiotic Use Flashcards
What are the 2 overall purposes of antibiotic stewardship?
- Limit inappropriate and excessive antibiotic use
2. Improve and optimize therapy and clinical outcomes for the individual patient
What are the 6 goals of antibiotic stewardship programs?
- Reduce antibiotic consumption and inappropriate use
- Reduce Clostridium Difficile Infections
- Improve Patient outcomes
- Increase adherence/utilization of treatment guidlines
- Reduce adverse Drug events
- Decrease or limit antibiotic resistance
What are 8 factors you should consider when choosing an antibiotic regimen?
- Spectrum of Coverage
- Patterns of Resistance
- Evidence for Track Record of specified drug
- Achievable concentration in serum, body fluid, or tissue
- Allergy
- Toxicity
- Formuation (IV vs. PO)
- Adherance to Regimine (2x per day vs. 6x per day)
Empiric Therapy
- When?
- What is used?
- number of drugs used?
- Diagnosis confidence?
- Side effects?
- Cost?
When:
- used when the infection is not well defined
What:
- Broad spectrum antibiotics are typically used
Number:
- Often multiple drugs are used
Diagnosis:
- Weak evidence for making diagnosis
Cost:
- More expensive
Directed Therapy
- When?
- What is used?
- number of drugs used?
- Diagnosis confidence?
- Side effects?
- Cost?
When:
- Infection is well defined
What:
- Narrow Spectrum Drugs used
Number of Drugs:
- one, seldom 2 drugs
Diagnosis confidence:
- Strong evidence supports the diagnosis
Side Effects:
- Fewer adverse reactions
Cost:
- Less expensive
Which therapy type is used more frequently, empiric of directed?
Empiric Therapy is most often used
Why is empiric therapy more commonly used?
- We need to act act quickly
- Difficult or Negative cultures
- Fear of missing something
- Continuing same drugs because they’ve worked in the past
How is directed therapy done?
- Obtain cultures
- Have the courage to make the diagnosis
- Don’t rely on response therapy
- Know situations in which direct therapy is definitely indicated
What are some diseases in which therapy used against them should definitely be directed?
- Acute Otitis Media (AOM)
- Community Acquired Pneumonia (CAP)
- Group A Strep. (us Penicillin)
What are the 4 Tenents of appropriate antibiotic use?
- Treat bacterial infection NOT colonization
- Don’t treat sterile inflammation or abnormal imaging without infection
- DO NOT treat viruses with antibiotics
- Limit duration of antibiotic therapy to an appropriate length.
What are 3 general causes of antibiotic market failure?
- Scientific
- Economic
- Regulatory
What is the GAIN act?
- how does it change medicine
- Added exclusivity for antibiotics for priority review
- based on the bugs they kill NOT the infection
What drives the cost of a drug in the U.S.
Fear of disease
Why is developing antibiotics not economically viable for drug companies?
- Cost a lot to develop
- Short Treatment duration
- 3 limited patient pool (any new antibiotics made will only be used as last resorts to avoid resistance)
