Antibiotic Therapy Flashcards
Types of antibiotic therapy
- ________ therapy
-__________ therapy - __________ therapy
empiric
definitive
prophylactic
Types of antibiotic therapy
-empiric therapy: to provide initial treatment when _____________________________
the identity of causative organisms isn’t known
Types of antibiotic therapy
-definitive therapy: treatment of any infection in which ____________________________________
the Aetiologic pathogen and its antibiotic susceptibility is known
Types of antibiotic therapy
-prophylactic therapy: to ___________ (______ type and _____ type)
prevent infection
medical
surgical
GOOD CLINICAL EVIDENCE OF INFECTION
*systemic inflammatory response
-heart rate is ___________
-respiratory rate is _______
-fever is ______ or _____
greater than 90b/min
greater than 20c/min
> 38 or < 36
Have relevant specimen been collected before commencement of antibiotic therapy?
*____________ testing: blood culture, urine culture , csf culture
*Prior antibiotic use may ____________ thereby _________
*_______ antibiotic use or _____ can fuel ____________
culture and sensitivity
damage bacteria without killing thereby preventing growth in vitro
inappropriate; overuse
antibiotic resistance
To aid empiric therapy
*biomarkers for infection such as ______,_______, and ________
*serum/plasma for antigen or antibody testing, PCR
Procalcitonin, C reactive protein , and white cell count
gram stain can help predict useful antibiotics
T/F
T
Choose antibiotics based on _______
lab results
When microbiological data is now available
*Use a _____ spectrum antibiotic to treat specific pathogens
*Re-evaluate antibiotic therapy based on ________ and _______ such as organism ID and the _______
*________ or ________ based on the susceptibility result
narrower
clinical response and microbiological data; antibiotic susceptibility testing
streamline or De-escalate
When microbiological data is now available
*Host factors
-____
-_______of site of infection
-age and underlying disease
-________ of illness
allergy
penetration
severity
When microbiological data is now available
*Multiple antibiotic use
-risk of _________
-some antibiotics may be _____
- __________
adverse drug reaction
antagonistic
superinfection
The more quickly the ————- of broad spectrum antibiotic coverage can be discontinued, the lower the risk of __________
selective pressures
selecting for highly resistant pathogens
When microbiological data is now available
Other principles
* Treat ______ and not ______
- _____ before ____ of _______ avoid inordinate delay)
- ______ evaluation of appropriateness of antibiotic therapy
infection; colonisation
Culture; initiation of antibiotics
Daily
When microbiological data is now available
Other principles
*___/_____ date
- Ensure all antibiotic prescription are _____
- Write _________ for antibiotic use in case notes
*Antibiotic prescription should comply with ________________________
Stop/review ; closed
indications (diagnosis)
antibiotic treatment guidelines in the hospital
Advantages of IV to Oral switch
• Reduced risk of __________ infections
• No risk of ________ in case of oral administration
cannula-related
thrombophlebitis
• which is less expensive between oral and IV therapy
Oral is Less expensive than IV therapy:
IV to Oral switch
• Reduction in the _____ costs which mainly refer to cost of ____,______ for administration, ———,———, and ______
hidden
diluents, equipments
needles, syringes, and nursing time.
In IV to Oral switch
• (Earlier or Later?) discharge
• (Reduced or Increased?) toxicity
Earlier
Reduced
When doing the IV to Oral switch
Make sure the Oral bioavailability can _______________________________________
Achieve serum concentrations comparable to antibiotics administered intravenously
The Golden Rules of Antimicrobial Prescribing: __________
MINDME
The Golden Rules of Antimicrobial Prescribing
Microbiology guides therapy wherever possible
Indications should be evidence based
Narrowest spectrum required
Dosage appropriate to the site and type of infection
Minimize duration of therapy
Ensure monotherapy in most cases
Antimicrobial resistance
• Resistance to antimicrobials is a __________ phenomenon that can be ______ by a variety of factors
natural biological
amplified
Antimicrobial resistance
• The use of an antimicrobial forces microbes to ____________ in a phenomenon known as “ ____________ “
either adapt or die
selective pressure
Bacteria will be killed rather than adapt
T/F
F
Bacteria will adapt rather than be killed
Antimicrobial resistance can occur when anti-microbials are used incorrectly.
- for ________ time
- at _______ dose
- at ______ potency
- for the _____ disease
• The microbes which ________ and ———- carry ________, which can be _________
too short a
too low a
inadequate
wrong
adapt and survive ; genes for resistance; passed on
Antimicrobial resistance
• Paradoxically, underuse through lack of _____, inadequate _____, poor _____, and substandard anti-microbials may play (equal, subpar, more?) role as overuse
access
dosing; adherence
Equal
Total consumption of antimicrobials is a critical factor in selecting resistance
T/F
T
Definition of Antimicrobial stewardship
• Refers to ____________ designed to ______ and _______ the ______ of antimicrobial agents by promoting the _______ of ______ antibiotic drug regimens including ______,_______, and ______
coordinated interventions
improve and measure
appropriate use
selection of optimal
dosing, duration of therapy and route of administration
The antimicrobial stewardship program is a/an (formal or informal?) program that ________ and ________ the __________ of antibiotics
Formal
Monitors and manages
appropriate use
Goals of The antimicrobial stewardship program
- _______ antimicrobial therapy
• right _____, _____, _____, ________
Optimise
selection, duration, dose, route of administration
Goals of The antimicrobial stewardship program
- Reduce _______ costs
• Limiting ________ and ______
treatment related
overuse and inappropriate use
Goals of The antimicrobial stewardship program
• Promote active _________ switch therapy
-Minimise adverse events
- Decrease the risk of development of _________
IV to PO
antimicrobial resistance
