Antibiotic Basics Flashcards
What is a huge concern regarding antibiotics right now
unnecessary antibiotic prescriptions! lots for ear infection and all rx for common cold which antibtiotics can’t tx!
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
Empiric tx
What are concerning issues with empiric tx
usually on multiple drugs, more adverse rxns, expensive
- Infection well defined
- Narrow spectrum
- One, seldom two drugs
- Evidence usually stronger
- Less adverse reactions
- Less expensive
Directed therapy
In directed therapy, tx is based on culture and susceptiblity results– interpretation of ____ or______ as S, I or R is bug-drug specific
MIC or KB zone
***You can’t just pick the one with the lowest MIC!!!
What are my drugs of choice to tx invasive MSSA infections?
Which do we not use?
Nafcillin (oxacillin) and Cefazolin
Quinolones like moxifloxican adn ciprofloxacin aren’t indicated for invasive MSSA
What are some negative effects of antibiotic use?
• Antibiotic resistance • Adverse drug events (ADEs) – Hypersensitivity/allergy – Drug side effects – Clostridium difficile infection – Antibiotic associated diarrhea/colitis • Increased health-care costs
ADEs from antibiotics resulted in 140,000 estimated ____ per year
ED visits
–antibiotics account for 19.3% of drug related adverse events
80% of those for allergic events
20% for adverse events
A big portion of ADEs are from which two classes of antibiotics
penicillin and cephalosporins
Why do we need to improve in patient antibiotic use?
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
How are antibiotics being misused?
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
Who has the highest rate of antibiotic use and infection with antibiotic resistant pathogens?
Children
colds/URI/bronchitis account for 20% of antibiotic prescriptions despite lack of evidence that they improve outcome
What are some misperceptions parents have on antibiotics?
- 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.
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
Antibiotic Stewardship
What is the purpose of the antibiotic stewardship?
- Limit inappropriate and excessive antibiotic use
* Improve and optimize therapy and clinical outcomes for the individual infected patient
Antibiotic Stewardship key points
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
What are the 6 goals of the Antibiotic stewardship
- Reduce antibiotic consumption and inappropriate use
- Reduce Clostridium difficile infections
- Improve patient outcomes
- Increase adherence/utilization of treatment
guidelines - Reduce adverse drug events
- Decrease or limit antibiotic resistance
Factors to consider when selecting an antibiotic
- Spectrum of coverage
- Patterns of resistance
- Evidence or track record for the specified infection
- Achievable serum, tissue, or body fluid concentration
- Allergy
- Toxicity
- Formulation (IV vs. PO); if PO assess bioavailability
- Adherence/convenience (e.g. 2x/day vs. 6x/day)
- Cost
What are three things to consider when making antibiotic choices
- Know the patient: duration of hospitalization, co-morbities, prior antibiotic use
- Identify site of infection
- Know the environment: patterns or resistance in your institution
What are some big hurdles to overcome with antibiotics?
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”
What are good references for prescribing antimicrobials?
Sanford guide to Antimicrobial therapy
Up to Date
Wake forest school of medicine “Get smart about antibiotics”
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
Aztreonam
Which of the following antibiotics has little activity against anaerobic bacteria? Meropenem Metronidazole Ceftriaxone Clindamycin Amoxicillin-Clavulanate
Ceftriaxone
