Antibiotic Basics

Question 1

What is a huge concern regarding antibiotics right now

Answer 1

unnecessary antibiotic prescriptions! lots for ear infection and all rx for common cold which antibtiotics can’t tx!

Question 2

Refers to the initiation of treatment prior to determination of a firm diagnosis… typically broad based and chosen according to likely pathogen, pt history and allergies

Answer 2

Empiric tx

Question 3

What are concerning issues with empiric tx

Answer 3

usually on multiple drugs, more adverse rxns, expensive

Question 4

• Infection well defined
• Narrow spectrum
• One, seldom two drugs
• Evidence usually stronger
• Less adverse reactions
• Less expensive

Answer 4

Directed therapy

Question 5

In directed therapy, tx is based on culture and susceptiblity results– interpretation of ____ or______ as S, I or R is bug-drug specific

Answer 5

MIC or KB zone

***You can’t just pick the one with the lowest MIC!!!

Question 6

What are my drugs of choice to tx invasive MSSA infections?

Which do we not use?

Answer 6

Nafcillin (oxacillin) and Cefazolin

Quinolones like moxifloxican adn ciprofloxacin aren’t indicated for invasive MSSA

Question 7

What are some negative effects of antibiotic use?

Answer 7

• Antibiotic resistance
• Adverse drug events (ADEs)
– Hypersensitivity/allergy
– Drug side effects
– Clostridium difficile infection
– Antibiotic associated diarrhea/colitis
• Increased health-care costs

Question 8

ADEs from antibiotics resulted in 140,000 estimated ____ per year

Answer 8

ED visits
–antibiotics account for 19.3% of drug related adverse events
80% of those for allergic events
20% for adverse events

Question 9

A big portion of ADEs are from which two classes of antibiotics

Answer 9

penicillin and cephalosporins

Question 10

Why do we need to improve in patient antibiotic use?

Answer 10

Antibiotics are misused in hospitals.. see up to 50% of antimicrobials are used inappropriately!
• Antibiotic misuse adversely impacts patients
and society
• Improving antibiotic use improves patient
outcomes and saves money
• Improving antibiotic use is a public health
imperative

Question 11

How are antibiotics being misused?

Answer 11

Given when they are not needed
• Continued when they are no longer 
necessary
• Given at the wrong dose
• Broad spectrum agents are used to treat very 
susceptible bacteria
• The wrong antibiotic is given to treat an 
infection

Question 12

Who has the highest rate of antibiotic use and infection with antibiotic resistant pathogens?

Answer 12

Children

colds/URI/bronchitis account for 20% of antibiotic prescriptions despite lack of evidence that they improve outcome

Question 13

What are some misperceptions parents have on antibiotics?

Answer 13

• 58% of thought antibiotics were necessary for a fever
• 58% for cough
• 32% believed antibiotics were necessary for the common cold.
• 70% of parents believed antibiotics were necessary for treatment of their child’s illness in a pre-visit survey.
• Parents expected antibiotics in 81% of cases that ultimately resulted in a bacterial diagnosis.
• Parents expected antibiotics in 66% of cases that ultimately resulted in a viral diagnosis.

Question 14

A system of informatics, data collection,
personnel, and policy/procedures which promotes the optimal selection, dosing, and duration of therapy for antimicrobial agents throughout the course of their use

Answer 14

Antibiotic Stewardship

Question 15

What is the purpose of the antibiotic stewardship?

Answer 15

• Limit inappropriate and excessive antibiotic use

* Improve and optimize therapy and clinical outcomes for the individual infected patient

Question 16

Antibiotic Stewardship key points

Answer 16

Is it pertinent to inpatient/outpatient and long term care settings
Practiced at the level of the pt and health care team
Needs to be a core function of the medical staff and utilizes the expertise and experience of clinical pharmacists, microbiologist, infection control

Question 17

What are the 6 goals of the Antibiotic stewardship

Answer 17

1. Reduce antibiotic consumption and inappropriate use
2. Reduce Clostridium difficile infections
3. Improve patient outcomes
4. Increase adherence/utilization of treatment
   guidelines
5. Reduce adverse drug events
6. Decrease or limit antibiotic resistance

Question 18

Factors to consider when selecting an antibiotic

Answer 18

1. Spectrum of coverage
2. Patterns of resistance
3. Evidence or track record for the specified infection
4. Achievable serum, tissue, or body fluid concentration
5. Allergy
6. Toxicity
7. Formulation (IV vs. PO); if PO assess bioavailability
8. Adherence/convenience (e.g. 2x/day vs. 6x/day)
9. Cost

Question 19

What are three things to consider when making antibiotic choices

Answer 19

1. Know the patient: duration of hospitalization, co-morbities, prior antibiotic use
2. Identify site of infection
3. Know the environment: patterns or resistance in your institution

Question 20

What are some big hurdles to overcome with antibiotics?

Answer 20

cultures are difficult to provide microbiologic definition or negative cultures
Provider beliefs; fear of missing something, not believing data available, myth of double coverage for gram-negatives and continuing on drugs “X, Y, Z”

Question 21

What are good references for prescribing antimicrobials?

Answer 21

Sanford guide to Antimicrobial therapy
Up to Date
Wake forest school of medicine “Get smart about antibiotics”

Question 22

What antibiotic out of the following would you use in someone who has history of life-threatening PCN allergy?
Ertapenem
Aztreonam
Ceftriaxone
Pipercillin/Tazobactum
Meropenem

Answer 22

Aztreonam

Question 23

Which of the following antibiotics has little activity against anaerobic bacteria?
Meropenem
Metronidazole
Ceftriaxone
Clindamycin
Amoxicillin-Clavulanate

Answer 23

Ceftriaxone