Antibiotic decision making Flashcards
Define antimicrobial stewardship
Coordinated interventions designed to improve & measure appropriate use of antimicrobials by promoting selection of optimal antimicrobial drug regimen, dose, duration of therapy & route of administration
What questions should be asked when making empirical decisions about antibiotic use?
Is there good evidence of bacterial infection?
What diagnostics will aid in decision-making?
When should cultures and sensitivity tests be used?
What drives the final antibiotic choice?
What are critically important antibiotics (CIAs), and why are they significant?
CIAs are vital for treating serious infections in humans.
Their misuse in veterinary medicine increases risk of antimicrobial resistance (AMR).
Examples: Carbapenems, vancomycin, Linezolid
Use as last resort
What are the European Medicine Agency (EMA) categories of antibiotics?
Category D (Prudence): First-line, narrow-spectrum choices.
Category C (Caution): Used when no D-category options are effective.
Category B (Restrict): Reserved for critical cases; use based on antimicrobial susceptibility testing (AST).
Category A (Avoid): Not authorized for use in food animals, only in exceptional circumstances for companion animals.
What factors influence antibiotic selection in vet med?
Cost and client preferences
Pharmacokinetics (e.g., dosage, duration, site of infection)
Host immune status and age
Risks (e.g., toxicity, flora effects, resistance promotion)
Antimicrobial sensitivity testing (AST)
What are the categories of antibiotics based on the British Veterinary Association (BVA) guidelines?
Primary (1st line): Narrow-spectrum, well-established antibiotics (e.g., penicillins, tetracyclines).
Secondary (2nd line): Broad-spectrum, used only when AST indicates (e.g., aminoglycosides, macrolides).
Tertiary (3rd line): Reserved for multi-drug-resistant (MDR) infections, based on AST (e.g., 3rd-generation cephalosporins).
Restricted: CIAs used only in exceptional cases (e.g., vancomycin, carbapenems).
What are the steps in avoiding antibiotic misuse?
Use diagnostics to confirm bacterial infections.
Avoid using CIAs as first-line options.
Follow the practice’s antimicrobial policy.
Educate clients about proper medication use.
What is the significance of the EMA and GRAM guides in veterinary practice?
They categorize antibiotics based on their importance in human and animal health.
Guides help veterinarians make informed, responsible decisions to minimize AMR risks.
What are examples of antibiotics in each EMA category?
Category D: Penicillins, 1st-generation cephalosporins.
Category C: Aminoglycosides, macrolides.
Category B: Fluoroquinolones, 3rd-generation cephalosporins.
Category A: Vancomycin, carbapenems.
What considerations are critical when using tertiary (3rd line) antibiotics?
Full identification of pathogen.
Antimicrobial sensitivity testing.
Justification that all primary & secondary options are ineffective
What are the BVA’s seven-point plan principles for antimicrobial use?
Work with clients to avoid need for antimicrobials.
Avoid inappropriate use.
Choose antimicrobials wisely.
Reduce use wherever possible.
Use laboratory testing to support decisions.
Monitor antimicrobial effectiveness
Educate clients & staff on responsible use
Why is antimicrobial sensitivity testing (AST) crucial?
Ensures selection of effective antibiotics.
Helps avoid resistance by identifying pathogen’s susceptibility
Prevents misuse of CIAs and higher-line antibiotics.
