Antimicrobial Stewardship

Question 1

goals of stewardship

Answer 1

patient outcome: increase cure rates, dec morbidity/mortality
patient safety: reduce consumption
resistance
healthcare cost

Question 2

common misuse of antibiotics

Answer 2

• prolonged prophylactic therapy
• prolonged empiric treatment without evidence of infection
• excess broad spectrum antibiotics
• adjust dose without accounting for pk/pd considerations
• failure to narrow therapy

Question 3

basic tenets of antimicrobial use

Answer 3

• obtain specimens before starting treatment
• once identified, choose narrowest spectrum
• use guides*
• use least expensive drug

Question 4

pk vs pd

Answer 4

pk: what the body does to the drug (absorption, distribution, metabolism, excretion)
pd: what the drug does to the bug (antimicrobial activity)

Question 5

time dependent bactericidal effect

Answer 5

• requires that the drug conc be above thhe mic for a certain percentage of dosing interval
• once target mic is reached, increasing drugs doesn’t have an effect
• goal: enhance duration of exposure
• all beta lactams

Question 6

concentration dependent bactericidal effect

Answer 6

• increasing bactericidal effect with increasing serum levels of the drug
• goal: enhance concentration
• aminoglycoside, daptomycin, quinolones, ketolides

AMIN DAPat QKETO

Question 7

auc/mic ratio

Answer 7

• efficacy depends on total concentration of the drug achieved over 24 hrs
• goal: enhance the amount of drug
• azithromycin, clindamycin, glycopeptides, linezolid, macrolides, tetracyclines

Question 8

what to take for covid

Answer 8

nonsevere: usual supportive care
severe: corticosteroids

Question 9

centor criteria

Answer 9

for acute tonsillar pharyngitis

• fever >100.5 F (38 C)
• absence of cough
• tender anterior cervical lymphadenopathy
• tonsillar exudate

score: 4 = treat, 2-3 = test with rapid antigen, treat if +, 0-1 = do not treat

Question 10

moderate risk cap

Answer 10

unstable vitals: rr >/= 30 pr >/= 125 temp <36 or >40, sbp <90, dbp <60, altered mental state, suspected aspiration, decompensated comorbid condition

cxr: multilobar infiltrates, pleural effusion or abscess

Question 11

high risk cap

Answer 11

moderate risk cap + severe sepsis and septic shock

needs mechanical ventilation

Question 12

curb 65

Answer 12

risk stratification for pneumonia

confusion
uremia, bun >7 mmol
rr >30
bp sbp <90 dbp <60
65 age

Question 13

curb 65 scoring

Answer 13

0-1 outpatiient
2 inpatient vs observation
>/=3 inpatient (14% mortality)
4-5 inpatient icu (27% mortality)

Question 14

preferred regimen for moderate risk cap

Answer 14

ampicillin-sulbactam iv
cefuroxime iv
ceftriaxone iv + azithromycin po
clarithromycin po
levofloxacin po

Question 15

regimen for low risk cap

Answer 15

amoxicillin, azithromycin, clarithromycin

Question 16

golden rule: mindme

Answer 16

microbiology guides therapy
indications should be evidence based
narrowest spectrum required
dosage appropriate to the site and type of infection
minimize duration
ensure monotherapy

Question 17

treatment duration

Answer 17

table 5