CA - Antibiotic resistance (TB) Wk 3

Question 1

What are the urgent public health threats / germs that require urgent & aggressive action?
What do they cause?

Answer 1

1. C-diff
   - causes diarrhoea & colitis
2. Carbapenem-resistant enterobacteriaceae
   - can cause pneumonia, bloodstream, wound, & UTIs

Question 2

What are the serious public health threats / germs that require prompt & sustained action?
What do they cause?

Answer 2

1. ESBL-producing Enterobacteriaceae
   - ESBL = extended-spectrum beta-lactamase > enzymes that break down antibiotics
   - group of bacteria that are resistant to common antibiotics
   - can cause infections in the bloodstream, urinary tract, and other parts of the body
2. Vancomycin-resistant enterococci (VRE)
   - usually found in intestines, female genital tract and environment (e.g., soil and water)
   - resistant to vancomycin, which is used to treat infections caused by enterococci
3. Methicillin-resistant staph Aureus (MRSA)
   - spread in hospitals, other healthcare facilities, and in the community.
4. Drug-resistant TB
   - form of TB caused by bacteria that are resistant to at least one TB medicine

Question 3

Whats empirical therapy?

Answer 3

best educated guess on which abx to give -> based on data on how susceptible certain bugs are

Question 4

Whats antimicrobial stewardship? What is the purpose of it?
(WILL HV 1 QN IN EXAMS)

Answer 4

1. Indication
   - do pts need abx?
   - are they on the correct drug?
2. Choice
3. Duration
   - how long do they need to take abx

Purpose: combat abx resistance

Question 5

How to improve abx prescribing & use?

Answer 5

1. Obtain cultures before starting therapy
2. Document indication & review date
3. Review & reassess abx at 48 hrs
4. Consider IV to oral switch
   - oral: lower conc -> lower risk of selective pressure for abx resistance
5. Seek advice for complex cases
6. Educate pts about abx use

Question 6

Whats MINDME?

Answer 6

M - micro bio guides therapy
I - indications should be evidence based
N - narrowest spectrum required
D - dosage appropriate to the site & type of infection
M - minimise duration of therapy
E - ensure monotherapy in most cases

Question 7

When should abx be stopped?

Answer 7

1. In pts unlikely to have infections
2. Narrow treatment after knowing the responsible pathogen
3. Switch to monotherapy after day 3 whenever possible
4. Discontinued after ~7 days for most pts