Antimicrobial chemotherapy Flashcards
What is the principle causing antibiotic resistance?
Misuse and overuse of antimicrobials in humans, animals and plants
Transplants, prophylaxis, veterinary etc
Exacerbated by
Creates a survival advantage of antibiotic resistance in bacterial
What other medical procedures are more difficult because of rising antibiotic resistance?
Surgery
Caesarean sections
Cancer chemotherapy
What are some consequences of arising antibiotic resistance bacteria?
High-cost treatment
Extended hospital stay - the risk of complications
Low productivity rate
Define antibiotic stewardship
Set of commitments and activities designed to optimise the treatment of infections whilst reduce the adverse events associated with antibiotic use now and in the future.
Right drug
Right person
Right time frame
What is an important alogrithm in antimicrobial stewardship?
Start smart then Focus
Often gives a broad range than goes to a narrow range.
How quickly should antibiotics be given after a diagnosis of sepsis?
1 hour
What are the antimicrobial stewardship guidelines for surgery?
Clean surgery - no prophylaxis needed
Clean surgery with prosthesis or contaminated surgery - one dose prophylaxis within 60mins, redose for longer procedures
Established infection - antimicrobial treatment according to guidelines.
What antibiotic should be given for meningitis initially?
Benzylpenicillin
What are the different types of antibiotic prescription?
Targeted therapy - definite microbiological result
Empiric therapy - assumed best
Prophylactic use
What factors should be considered when prescribing empirical antibiotics?
Allergies
Drug interactions
Presumed organism/diagnosis - epidemiology and suspectibility
Site of infection
Severity of infection
Previous microbiology results
Route of administration - oral v IV - GCS, V&D.
Effect on normal bacterial flora
What are some potential complications of antibiotic use for a patient?
Antibiotic associated diarrhoea
Oral and vaginal candidiasis
Colonisation or infection by resistant bacteria
Cannula site infection/central line infection
How does the reaction of a penicillin ‘allergy’ affect treatment restrictions?
- Vague or minor (e.g GIT distrubance) - beta lactams may be justified
- Non-urticarial rash - cephalosparins, carbapenens and monbactma may be used with caution
- Urticarial rash, angio-oedema or anaphylaxis - all beta-lactams are contraindicated
Who should be contacted for antimicrobial advice?
- BNF
2, Local antimicrobial policy - National antimicrobial policy
- Senior colleagues
- Microbiology/infectious diseases
What conc of bacteria is significant in urine when determining risk of UTI?
> 10^5 cfu per ml
How does the wbc profile differentiate between the source of infection?
Neutrophil - bacterial
Lymphocyte - viral
Eosinophils - parasites
What antibiotic should be used based on the patients CURB65 score for CAP?
0 or 1 = amoxicillin or doxycycline
2 = amoxicillin with clarithormycin
3 or 4 = IV co-amox with oral clarithromycin
What antibiotics are active against MRSA?
Vancomycin
Teicoplanin
Doxcyclines
Ceftaroline
What commonly causes diarrhoea after antibiotics?
Antibiotic-associated Diarrhoea
This may be form a C.diff infection
What is the treatment for C.diff?
Vancomycin -> oral
Fidaxomicin = second line
How can the risk of C.diff associated diarrhoea be reduced?
By a combination of prudent antibiotic use
Environmental cleanliness
Hand hygeine
What is the typical treatment plan for an acute sore throat?
Use FeverPAIN or centor score for assessing symptoms
FP 0/1 = no antibiotics
FP 2/3 = back up antibiotic prescription
FP 4/5 - immediate antibiotic or back up prescription
All encourage paracetamol and fluids
What is the typical treatment for necrotising fascitis?
Surgery
Followed by IV clindamycine and piperacillin/tazobactam
