Antibiotic Stewardship Flashcards
How many more microbial cells than human cells are there in our bodies?
10 times more
What is the problem with having a natural flora when prescribing antibiotics?
They might attack our healthy flora, and lead to pathogenic colonisation by a different bacteria instread
What is the most narrow spectrum antibiotic?
Penicillin V
- streptococcus and some aneorobic action
List four penicillins in order of most narrow spectrum to most wide spectrum.
Penicillin V
Flucloxacillin
Amoxicillin
Co-amoxiclav
In what way are broad spectrum antibiotic bad?
It will not only get rid of the causative organism, but cause damage to the natural flora if they fit into any of the other categoires that the antibiotic also effects
What are the effects on the individual if given too wide a range antibiotic?
Resistance Drug reaction/interactions/ toxicity - particularly macrolides C.diff infection Vascular site infection
What are the effects on the population if lots of people are given too wide a range antibiotic?
Resistance
C.diff infections increase
What is antibiotic stewardship and why is it useful?
Programme to ensure safe and appropriate antibiotic use
- optimize outcome
- minimise collateral damage
- reduce resistance and C.diff
How is antibiotic stewardship achieved?
Monitoring Guidelines Specific restrictions Specific interventions Multidisciplinary work Both in the hospital and in the community
How is antibiotic prescription regulated?
Efficacy of the drug - give the appropriate treatment Realise when they aren't needed Choice of agent - likely organism and resistance - C.Diff risk - cost Duration - people are leaning towards high doses for shorter periods of time Antibiotic review - IVOST - simplification - stop (esp in hospitals) - escalation Protected agents (meropenem) Indications for specialist input
What is the role of the lab in the AMS programme?
Optimisation of diagnosis - minimisation of over diagnosis
Restriction of reporting organisms to prevent over treatment
Restricted reporting of sensitivities to reduce use of inappropriate agents
Co-ordination of clinical advice with guidance
When should antibiotics not be prescribed? (in community and hospital)
Viral infection
Self limiting RTIs (50% of inappropriate prescribing)
Asymptomatic bacteruria, uncomplicated cystitis (self-limiting and often viral)
Ingrowing toe nail
Varicose eczema - mistaken for cellulitis
Systemic inflammatory response due to cancer, ischaemia or inflammation
When should you take a urine sample from someone to test for a UTI and why?
You should take it only if they have urinary symptoms because 40% of elderly women have asymptomatic bacteruria, which doesn’t need to be identified and treated
How should an uncomplicated UTI be managed?
NSAIDs are just as effective as antibiotics
Antibiotics are only given if the patient doesn’t get better, or gets worse
How should a catheter associated UTI be managed?
Remove the catheter and wait
Treat with antibiotics only if the patient has symptoms or becomes septic
When should non-antibiotic measures be taken?
Mainly in primary care
Requires reassurance and explanation
Management of the symptoms is still needed
- fluids and analgesia
Set up a delayed script in case their symptoms don’t get better
Set up a review date/opportunity
When should antibiotics be given?
When there is a strong suspicion of a bacterial infection
What localising symptoms/signs are you looking for that would suggest antibiotic treatment?
Dysuria and frequency
Dyspnoea, cough, green/brown sputum and crepitations
Erythema, heat and swelling
Sore throat with exudate and adenopathy
What antibiotics should be used for a non severe infection?
Narrow spectrum agents
LRT - amoxicillin or doxycycline
Lower UTI - trimethoprim or nitrofurantoin
Cellulitis - flucloicillin or clarithromycin
What kinds of antibiotic therapy are used for severe/life threatening infections?
IV combined treatment (often a beta-lactam and gentamicin)
Use of protected antibiotics
Within an hour of admission
Which antibiotics are particularly implicated in causing C.diff infections?
Cephalosporins Ciprofloxacin Co-amoxiclav (beta-lactam-betalactamase inhibitors) Clindamycin Carbapenems
What are the first antibiotic treatments given to a person if the causative organism isnt know?
IV Benzylpenicllin - streptococcus species
IV Flucloxicillin - MSSA
IV Gentamicin - gram negative cover
How do you assess response to antibiotic treatment?
Clinical, micro results De-escalate (simplify, switch, stop) Review IV daily - switch to oral Duration depends on the infection Specialist input Source control - catheter etc
What are the toxicity problems of Gentamicin?
Renal dysfunction
Shouldn’t be given for more than three days
Has a very narrow therapeutic range
