6- Anti microbials Flashcards
Which antimicrobials are available to Orthoptists, and what are they used for?
C, F
Orthoptists have access to Chloramphenicol and Fusidic acid.
What is Chloramphenicol and Fusidic acid used for
These are used for treating acute bacterial conjunctivitis and for prophylactic management of** corneal abrasions.**
What are the available forms of Chloramphenicol?
Chloramphenicol is available as 0.5% Minims and 1% ointment.
What is the classifications of Chloramphenicol
P medicine for individuals over 2 years
POM for those under 2 years.
What is Fusidic acid, and why is it considered second-line medication?
Fusidic acid is a 1% modified-release eye drop containing benzalkonium chloride as a preservative.
It is expensive and typically used when Chloramphenicol is contraindicated
What are the advantages of Fusidic acid over Chloramphenicol?
Fusidic acid has a viscous nature, allowing it to stay in the eye longer, reducing the frequency of application, making it suitable for patients unable to use drops frequently.
How does bacterial conjunctivitis typically resolve, and how does treatment affect it?
Bacterial conjunctivitis is self-limiting, typically resolving in 7-10 days.
Treatment with antimicrobials can reduce this time by one day.
What percentage of acute infectious conjunctivitis cases in children are bacterial?
Approximately 78% of acute infectious conjunctivitis cases in children are bacterial.
What are the clinical features of acute bacterial conjunctivitis?
(5) MMMBC
Mucopurulent discharge
Minimal vision impact
Mild eye irritation
Bilateral pink eye
Crusted lashes
How can lymph node status help differentiate types of conjunctivitis?
Raised lymph nodes indicate viral conjunctivitis, while non-raised nodes suggest bacterial or allergic conjunctivitis.
What is the typical presentation of acute bacterial conjunctivitis in children?
Children may have a bilateral infection with crusted lashes and no associated fever,
What is a key factor in the spread of bacterial conjunctivitis?
Contaminated fingers are the most common method of spreading bacterial conjunctivitis, emphasizing hand hygiene.
Why is accurate diagnosis of bacterial conjunctivitis essential?
It ensures ruling out sight-threatening diseases and may involve obtaining conjunctival cultures, especially in neonatal cases.
What are the common pathogens causing bacterial conjunctivitis in adults and children?
In adults, Staphylococcus aureus is common, while in children, Streptococcus pneumoniae and Haemophilus influenzae are typical pathogens.
What are the two major considerations in deciding to treat bacterial conjunctivitis?
-The severity of the infection
-The patient’s risk factors
The self-limiting nature of the disease V benefit of quicker remission when treated with antimicrobials
How does antimicrobial resistance impact treatment decisions?
Resistance is an escalating problem, prompting cautious prescribing and education to ensure effective future treatments.
What does the UK Five Year Antimicrobial Resistance Strategy aim to address?
It focuses on optimizing prescribing practices and improving education, training, and public engagement regarding antimicrobial use.
What benefits were observed in early and late stages of conjunctivitis treatment with antimicrobials?
Early stages (days 2-5) showed better remission rates, while late stages (days 6-10) also indicated modest improvements.
What do recent Cochrane reviews say about antibiotic use in bacterial conjunctivitis?
Antibiotics reduce clinical and microbiological cure times and improve therapy completion rates compared to placebo.
What is antimicrobial stewardship?
It promotes effective use of antimicrobials to combat resistance and ensures these treatments remain viable options for infections.
What is a common expectation from carers of patients with conjunctivitis, and how should it be addressed?
Carers often expect medicinal treatment, but education is necessary to modify expectations, particularly for self-limiting conditions like bacterial conjunctivitis.
What is the recommended treatment regime for Chloramphenicol eye drops?
Apply one drop every two hours, reducing frequency as infection improves, and continue for 48 hours after healing.
How is Chloramphenicol eye ointment used as an alternative treatment?
Apply at night for severe infections alongside daytime drops or three to four times daily if used alone.
How frequently is Fusidic acid applied for bacterial conjunctivitis?
Twice daily for both adults and children.
What are the contraindications for Chloramphenicol?
P,B,BD
Pregnancy
Breastfeeding - grey-baby syndrome risk
Blood dyscrasias.
What risks are associated with Chloramphenicol use in the USA?
Aplastic anemia, though extremely rare with eye drops.
What is the drug of choice if Chloramphenicol is contraindicated?
Fusidic acid, unless the patient has a known sensitivity to it or its components.
How should Chloramphenicol Minims be stored?
Between 2-8°C. If stored at room temperature, they must be used within 28 days.
At what temperature should Fusidic acid be stored?
Below 25°C.
What is the main preservative in Fusidic acid eye drops?
Benzalkonium chloride.
What is the role of the Department of Health in combating antimicrobial resistance?
It provides strategies like education and prescribing optimization in documents like the UK Five Year Antimicrobial Resistance Strategy.
Why is hand hygiene critical in managing bacterial conjunctivitis?
To prevent the spread of infection, which commonly occurs through contaminated fingers.
What should practitioners do before diagnosing bacterial conjunctivitis?
rule out…..
Rule out sight-threatening diseases and consider conjunctival cultures if necessary.
How do antimicrobial treatments compare to placebo in bacterial conjunctivitis?
Treatments show faster remission and better compliance compared to placebo.
What is the duration for antimicrobial treatment continuation after infection control?
Treatment should continue for 48 hours after healing.
What are the signs and symptoms of bacterial conjunctivitis that differentiate it from viral conjunctivitis?
discharge type
effected eye
age
systemic illbess and lymphadenopathy
BC- mucopurlent discharge and bilateral, younger kids, no associated lymphadenopathy or systemic illness
VC- watery discharge, unilateral, older kids , lypmphadenopathy and systemic illness
What are the risks of untreated bacterial conjunctivitis?
While not sight-threatening, untreated cases may take longer to resolve and increase the risk of spreading.
What additional measure is recommended for severe bacterial conjunctivitis infections?
Use of Chloramphenicol ointment at night in combination with daytime drops.
How does Fusidic acid’s viscous nature benefit its application?
It prolongs contact time in the eye, requiring less frequent application.
What strategy should be employed for changing public perceptions of antibiotic use?
Educating carers and patients about the self-limiting nature of some infections and the importance of antimicrobial stewardship.
How long does bacterial conjunctivitis typically last without treatment?
7-10 days.
What clinical review supports the use of antimicrobials in acute bacterial conjunctivitis?
Cochrane reviews highlight improved cure times and therapy adherence with antibiotics.
What did the Cochrane review find about the use of antimicrobials in acute bacterial conjunctivitis?
The review showed that antibiotics reduced clinical and microbiological cure times and were associated with better therapy completion rates compared to placebo.
How do remission rates compare between early and late stages when using antimicrobials?
Early remission (days 2-5) showed significant improvement, and late remission (days 6-10) showed modest improvements with antibiotic use.
Which pathogens commonly cause bacterial conjunctivitis in adults and children?
In adults, Staphylococcus aureus is common
In children, Streptococcus pneumoniae and Haemophilus influenzae are typical.
What are key differences between bacterial and viral conjunctivitis symptoms?
Viral conjunctivitis often includes febrile symptoms and raised lymph nodes, while bacterial conjunctivitis lacks systemic illness and has crusted eyelids.
When is conjunctival culture recommended in bacterial conjunctivitis?
For infectious neonatal conjunctivitis or when the diagnosis is uncertain, to rule out sight-threatening diseases.
Why is Chloramphenicol rarely used in the USA?
Due to its association with aplastic anemia, though this is extremely rare with eye drops.
What are the storage requirements for Chloramphenicol Minims?
They must be stored at 2-8°C and used within 28 days if stored at room temperature.
What are the key components of antimicrobial stewardship?
It includes optimizing antimicrobial use, educating practitioners and the public, and addressing patient expectations to reduce unnecessary prescriptions.
Why is Fusidic acid preferred in certain cases over Chloramphenicol?
Fusidic acid does not pose risks such as grey-baby syndrome or blood dyscrasias and is better tolerated in some patients.
How can healthcare professionals modify patient expectations regarding treatment?
By educating carers on the self-limiting nature of bacterial conjunctivitis and the risks of unnecessary antimicrobial use.
