Antibiotic Decision Making

Question 1

What is antimicrobial stewardship

Answer 1

Coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration.

Question 2

What are CIAs?

Answer 2

Critically Important Antibiotics
These are last resort antibiotics

Question 3

What are some examples of CIAs?

Answer 3

Carbapenems
Linezolid
Vanmyocin

Question 4

What are the levels of antimicrobials under the EMA categorisation?

Answer 4

D - prudence
C - Caution
B - restrict
A - avoid

Question 5

What are the 7 points of the BVA 7-point plan for responsible antibiotic use

Answer 5

Work with clients
Avoid inappropriate use
Choose the right drug
Monitor antimicrobial sensitivity
Minimise Use
Record and justify deviations from protocols
Report suspected treatment failure to VMD

Question 6

What factors should be considered when choosing whether or not, and which antimicrobial to choose?

Answer 6

Empirical selection (Cat D, C, B)
Pharmacodynamic considerations
Risks of drug class (toxicity, effect on flora etc)
Food Animals
Client factors (cost, ability etc))
Principles of treatment (dosage, duration, site etc)

Question 7

What makes an antimicrobial a primary (Cat D)?

Answer 7

Well established
Good evidence of efficacy
Ideally sleet narrow spectrum
Should be used wherever appropriate / possible

Question 8

Give examples of Cat D (primary) antimicrobials

Answer 8

Penicillins
Amoxycillin

Question 9

Give examples of Cat C (secondary) antimicrobials

Answer 9

Narrow spectrum:
- Aminoglycosides
- Metronidazole
- Macrolide
Broad Spectrum:
- Chloramphenicol
CIAs:
- Fluoroquinolones
- Macrolides

Question 10

Give examples of Cat B (tertiary) antimicrobials

Answer 10

3rd and 4th generation cephalosporins
Rifampicin
Fosfomycin