4 Antibiotics again Flashcards
C. diff measures
Suspect - no clear cause of dia Isolate (ensuite and no traffic) Gloves & aprons Hand washing (not alcohol) Test stool for toxin
Risk factors for c diff
Age, chronic conditions, antibiotic use disrupting gut flora
Other drugs that put you at c.diff risk
PPIs
Tx basic c diff
Fluids and electrolytes. Stop PPI unless clear indication. Stool sample and test. Not antidiahorreals! Oral metronidazole. 500mg tds 10days
Tx advance c diff
Oral/Colonic vanc
Fecal transplant
Why ORAL vanc
not absorbed, stays in gut
therefore no leveling
C diff toxin stays in the gut for
28days
Why do we monitor Vanc?
Renal tox
When to monitor vanc?
Pre-dose (11-12h) before 3rd dose
Then twice/week
When to monitor Gent?
Pre-dose (18-24h) before 2nd dose
Then twice/week
Why monitor Teicoplanin?
For efficacy
Why monitor Gent?
Ototoxicity/nephrotocity
Desired level Vanc?
10-15mg/ml
Desired level Gent?
less than 1mg/ml
Wait for levels before giving dose?
For patients >65 yrs, those with renal impairment or those who have had high levels reported previously, WAIT for the result before giving the next dose.
How often to measure Teic?
After 4 days
Then weekly
Advantages of IV
Quick
BA
Suitable for most pt (nil by mouth)
Avantages of oral
Cheaper (medicines and time) No IV infection risk Easier to admin/less risk of error Reduces pt discomfort Don't need to be in hospital Reversible
How to monitor infection severity?
CRP, BP, temp, WCC
Factors to consider for emperical treatment (3)
Site of infection (blood supply, abscesses, intracellular pathogens).
Properties of the antibacterial agent (tissue penetration, bioavailability, route of administration)
Concentration required to treat infection (MIC of organism)
Common UTI
e coli
Common CAP
Strep pneumoniae
Common HAP/cullulitis
S aureus
Mild CDI
not associated with increase WCC (<3 type 5+stools/day)
