Antimicrobials in the ER Flashcards
Why should we care about overusing antibiotics?
Patient impacts
- adverse effects and unintended consequences (vomiting/diarrhea, long term changes to normal flora, alzheimers or depression)
- the juvenile gut is the most susceptible
Global impact
- emergence of resistant bacteria
- pace of new antimicrobials is slowing
- crossover between human, animal and environmental health
T/F: antibiotic usage can affect not only the animal you are treating, but all of the other patients in the room can start to develop resistance
True- scary
What are the reasons that antibiotics are so commonly over-prescribed?
-clients want a fix
- veterinarians want to be the fixer (a larger issue than the client wanting a fix)
- there are internal and external pressures to do something
- we are in a rush
- lack of understanding
T/F: if you have never had a patient come back needing an antibiotic that you didn’t prescribe you are overprescribing antibiotics
True
What are the indications for prescribing antibiotics?
There is a known bacterial infection
- determined through culture or cytology (sample from sterile site and evidence of intracellular bacteria)
Suspected bacterial infection
- clinical signs fit (fever + pus), saw bacteria on cytology that were not intracellular, waiting on culture
- other diseases have been ruled out (cancer, other infectious causes)
What does a fever indicate?
Inflammation, not infection
- not all infections are caused by bacteria
- not all inflammation is caused by an infection
What are some common instances that antimicrobials are prescribed inappropriately?
-acute diarrhea in dogs and cats (most common reason)
-lower urinary tract signs in cats (very uncommonly due to infection)
-upper respiratory infections in dogs or cats (most commonly viral)
-acute coughing
-otherwise stable patients without clear indications of an infection
-every febrile patient (there are a lot of non-bacterial causes of fevers)
-every sick patient
What is the reason that antibiotics are more currently prescribe for dogs/cats over humans?
Their diarrhea is a nuisance to the owner
What are some reasons that you would maybe use antibiotics in a diarrhea case?
- Going on for more than a week
- dehydration, anorexia
- lethargy
What questions should you ask yourself if you suspect an infection?
-ask yourself what the signs are that are suggestive of an infection, what type of infection is most likely
-is there any known syndrome that could cause these signs and is that syndrome caused by bacterial infections
-where do you think the site of the infection is (what tissue is affected)
-can you collect a sample for C/S: if you can, do it, if not why cant you (shouldnt be suspecting bacteria if you cant determine site)
*if patient is otherwise stable and healthy- consider monitoring for a couple days before prescribing anything
If you just have a fever, what type of infection is most likely?
Viral
Once youve decided to start an empiric antibiotic, what are the next set of questions you need to ask yourself?
- What is the known or suspected tissue affected
- What bacteria typically colonizes that area
- What antimicrobials get that bug
- What type of antimicrobials get to that tissue
- What are the potential adverse effects of that drug
What are the main risk factors for resistance?
-prior recent antimicrobial use (within 90 days)
-hospital acquired infection
-long standing infection
-surgical implants
-client works in a hospital
What book did Dr. Connor recommend for effective antimicrobial treatment?
Target book- ask Dr Davis about this
T/F: the sicker the patient, the more aggressive the empiric therapy should be
True
- should start broad spectrum and then narrow down
*if minor infection, can start with a more specific antimicrobial and then broaden or change as necessary
