Antimicrobial Stewardship

Question 1

What are the risks of antimicrobial resistance?

Answer 1

AMR infections have worse outcomes
Pharma isn’t making new antimicrobials — we need to preserve the ones we have

Question 2

What are some causes of AMR globally?

Answer 2

↑ travel and medical tourism
Inappropriate use in agriculture/food sector
Poor medical rx practices
Inappropriate use and expectations by public
Poor quality antimicrobials
Lack of rapid and cheap dx tools
Poor data and AMR surveillance systems
Lack of R&D of new antimicrobials

Question 3

What are some appropriate uses of antibiotics?

Answer 3

Make sure it’s bacterial infection before tx
Tx significant, non-self limiting infections
Tx as narrow spectrum as possible
Stop abx at improvement
Control source of infection

Question 4

What are some secondary consequences of inappropriate antibiotic use?

Answer 4

Loss of healthy microbiome
Abx toxicity
Wasted drug cost
Miss true dx

Question 5

What are some causes of physician over-prescribing?

Answer 5

Dx unknown
Pt demands
Rx is faster
MD incentive for high pt turnover

Question 6

Is there any advantage to IV abx over PO?

Answer 6

No
They serve the same benefit

Question 7

What are steps that hospitals take to carry out antimicrobial stewardship?

Answer 7

Monitor AMR
Monitor usage
Prospective audit and feedback
Clinical practice guidelines
Pharmacy autosub
Education

Question 8

What are the Choosing Wisely outpt management of otitis media?

Answer 8

Dont give to vax’d >6mo unless:
Perforated tympanic membrane
Bulging tympanic membrane AND one of the 3:
Fever (≥39C)
Moderately or severely ill
Sig S&S lasting >48hrs

Question 9

What are the Choosing Wisely outpt management of pharyngitis?

Answer 9

• Rx only if Centor score ≥ 2 AND throat swab confirming GAS

Question 10

What are the S&S suggestive of viral pharyngitis rather than bacterial?

Answer 10

Rhinorrhea
Oral ulcers
Hoarseness

Question 11

A pt presents to your clinic with sinusitis. Her S&S have persisted for 7 days and have not improved with steam or nasal rinsing. She reports facial pressure that improves in the evening. Are abx appropriate in this situation?

Answer 11

No
She is only suffering from one of the PODS symptoms. It also improves in the evening therefore isn’t severe. She should be managed symptomatically with anti-inflammatories, decongestants, and/or steroids

Question 12

What are the PODS symptoms in context of sinusitis?

Answer 12

P: Facial pressure/pain/fullness
O: Nasal obstruction
D: purulent/discoloured nasal or postnasal discharge
S: hyposomia/anosmia

Question 13

A 45 y/o pt presents to your clinic with exacerbation of bronchiolitis. They are producing green sputum and are afebrile. Are abx appropriate in this situation?

Answer 13

No
Abx aren’t rx for bronchitis/asthma/bronchiolitis exacerbations

Question 14

A pt has an abscess drained and flushed. After sx, the area remains red and warm. The pt also c/o pain local to the area of drainage. Is abx use appropriate in this situation?

Answer 14

Yes
The pt is having S&S of localized skin infection despite drainage of the abscess.

Question 15

Should bacteruria always be tx with abx?

Answer 15

No
Abx should only be used if the pt is having S&S of a UTI, not if they are asymptomatic and happen to have bacteria in their urine

Question 16

There are 6 AMS interventions

Answer 16

Admin support to dev targets — % reduction in use, C.diff, AMR
Measure use and appropriateness regularly
Audit and feedback of personal practice
Peer comparison
Remove penicillin “allergy”
Sx prophylaxis — abx in sx not after