ANTIMICROBIAL STEWARDSHIP Flashcards

1
Q

What is antimicrobial stewardship?

A

(1) Reduction in inappropriate ABx use
(2) Improvement in susceptibility profiles of hospital pathogens
(3) Better selection, dosing, route of administration, and therapy duration of ABx

To REDUCE ABx resistance

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2
Q

Why is antimicrobial stewardship important?

A

Drug resistant pathogens have an impact on care

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3
Q

What are the 7 antimicrobial stewardship strategies?

A

(1) Formulary restriction
(2) Review/ audit + feedback
(3) Education + guidelines
(4) Streamlining/ de-escalation
(5) IV -> Oral
(6) Antibiotic cycling
(7) Supplementary strategies

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4
Q

What is the formulary restriction in antimicrobial stewardship? What are the pros and cons?

A
  • Restricted dispensing for certain ABx
  • AMS team must be contacted by prescriber

+
ø Direct control of ABx
ø Cost-effective
ø Ensures appropriate therapy

-
ø Loss of autonomy for prescribers
ø Time-consuming

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5
Q

What is review/ audit + feedback in antimicrobial stewardship? What are the pros and cons?

A
  • Daily review of ABx appropriateness
  • Steward (pharmacist) gives feedback to prescriber

+
ø Maintained prescriber autonomy
ø Individual education

-
ø Compliance is only voluntary
ø Increases workload of pharmacist
ø Reactive, rather than proactive

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6
Q

What are education/ guidelines in antimicrobial stewardship? What are the pros and cons?

A
  • Can be issued by NHS or government
  • Education of clinicians

+
ø Maintained prescriber autonomy
ø May alter behaviour patterns

-
ø Mostly ineffective by itself

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7
Q

What are streamlining/ de-escalation in antimicrobial stewardship? What are the pros and cons?

A
  • Use of results-based therapy
  • Use of patient-specific rather than broad-spectrum

+
ø Avoids long-term broad-spectrum ABx
ø Reduces resistance risk

-
ø Increased pharmacist workload
ø Sample-processing time

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8
Q

What is the IV to Oral switch in antimicrobial stewardship? What are the pros and cons?

A
  • Use of oral ABx in hospital
  • Many oral ABx have good absorption + bioavailability

+
ø Avoids entry site infections
ø Cost savings

-
ø Compliance

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9
Q

What is antibiotic cycling in antimicrobial stewardship? What are the pros and cons?

A
  • Avoids resistance to any single antibiotic
  • Aims to slow resistance

+
ø May reduce drug resistance by changing selective pressure

-
ø Adherence
ø Effectiveness lacks evidence

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10
Q

What are the supplemental strategies in antimicrobial stewardship?

A

(1) Decrease ABx usage
(2) Mathematical modelling
(3) Combination of the other 6 strategies

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