Antimicrobials

Question 1

what are potential healthcare impacts of inappropriate antimicrobial prescriptions?

Answer 1

1. adverse effects in patients (v/d, changes to normal flora, neurologic implications such as alzheimers or depression)
2. emergence of resistant bacteria
3. the pace of new antimicrobials is slowing
4. there is a lot of cross over between human, animal, and environmental health

Question 2

why do veterinarians tend to prescribe antibiotics when they are not really necessary?

Answer 2

1. client pressure (ext pressure)
2. vet pressure (internal pressure to want to fix the issue)
3. in a rush and too busy to educate client on why the pt may not need an antibiotic
4. lack of understanding

Question 3

T/F: if you have never had a patient come back needing antibotics that you did not intially prescribe, you are overprescribing antibiotics

Answer 3

true

Question 4

when SHOULD you prescribe antibiotics?

Answer 4

1. a known bacterial infection (supported by cytology with intracellular bacteria sampled from a sterile site or culture)
2. suspected bacterial infection

Question 5

T/F: if a fever is present, then infection is present

Answer 5

false – fever equals inflammation. and not all inflammation is caused by infection. and not all infections are caused by bacteria (parsitic, viral, fungal)

Question 6

what are common situations where antibiotics are prescribed inappropriately?

Answer 6

1. acute diarrhea
2. lower urinary tract signs in cats
3. upper respiratory tract infections
4. acute coughing
5. otherwise stable patients without clear indication of infection
6. every febrile patient
7. every sick patient

Question 7

T/F: you should reconsider antibiotics if you cannot pinpoint where you think the infection is or if signs are consistent with a common syndrome in which antibiotics are not recommended

Answer 7

true

also if the patient is otherwise stable and healthy, you can monitor them for a couple of days.

Question 8

if you decided that you are going to pursue antibiotic therapy, what questions do you need to ask/answer in order to choose an appropriate antibiotic?

Answer 8

1. what is the known or suspected tissue affected?
2. what type of bacteria typically colonizes there?
3. what antimicrobials get that bug?
4. what type of antimicrobials get to that issue?
5. what are the potential adverse effects of that drug?

Question 9

what are risk factors for patients being resistant to an empirical antimicrobial choice?

Answer 9

1. prior, recent antimicrobial use (90 days)
2. hospital-acquired infection
3. long-standing infection
4. surgical implants
5. client works in hospital

Question 10

T/F: the severity/degree of patients illness does not dictate the aggressiveness of the empirical antibiotic therapy, but rather the specific bacteria type does.

Answer 10

false the sicker the patient, the more aggressive your empiric therapy should be.

start broad spectrum IV. You can de-escalate once your c/s results are back.

Question 11

T/F: longer antibiotic courses are required in order to fully eliminate the infection and reduce recurrence rates

Answer 11

false – shorter courses should be utilized if possible.
ex. UTI - tx for 3-5 days

Question 12

T/F: when choosing empirical antibiotic therapy, you should start with a narrow spectrum antibitoic, then switch to broad if necessary

Answer 12

false – start broad, go narrow. or if new evidence emerges or non-infectious diagnosis is made, then stop the antibiotics.,

Question 13

T/F: in cases of pneumonia, septic peritonitis/surgical dehiscence, or pyelonephritis, aggressive antimicrobial therapy is needed.

Answer 13

true because these are life-threatening illnesses.