CD-05 Flashcards
What is Antibiotic?
Antibiotic produced by a microorganism which inhibits the growth of other microorganisms.
What is Antibacterial?
Produced by a microorganism
All antibiotics are antimicrobial but not all anti-microbial are antibiotics.
What is the definition of Antimicrobial?
Substance (synthetically or biological) that inhibits the growth of microbes.
Selective toxicity?
selectively kills or inhibits the growth of microbes
while causing minimal or no harm to the host. (it is an important quality for an antimicrobial drug is selective toxicity)
With Gram negative bacteria the crystal violet is washed away leaving the red safranin dye?
Yes
What acts as a virulence factor in bacteria?
Bacterial CAPSULES act as virulence factors
What protect bacteria from stress?
Bacterial spores
Bacteria reproduce by?
Binary fission (divide One body into two new bodies via asexual reproduction)
What are the key stages of microbial pathogenesis?
Exposure ->Adherence->Invasion->Replication
Which types of bacterial Cell wall mainly consists peptidoglycan?
Gram negative
cell wall Peptidoglycan and Lipid?
Gram Negative
Endotoxin?
Toxin is part of the bacteria
Exotoxin?
Toxin is secreted by the bacteria
Pathology?
study of causes and effects of injury
Pathogenesis?
Development of a disease
NICE Guideline means?
National Institute for Health and Care Excellence
Fever in under 5s
Patients age under 5 years Do not use ANTIPYRETIC for sole reason of reducing fever?
Disease of human depends on?
Microbes and Host so therefore treat host factors as well.
Fever in under 5s?
Assessment and initial management.
How antimicrobials are different from another drug use?
Abuse potential MDR
Impact on patient’s immediate community and Global community.
Goals of antimicrobial therapy?
Cure a diagnosed infection (individual)
Minimise adverse events (individual)
Minimise adverse events (society) by resistance
How We can realise Is the Patient Infected?
Feeling hot/cold • Swelling, heat, or erythema • Purulent discharge • Sputum (cough) production (Change in amount/colour/SOB) • Diarrhea or vomiting • Confusion • Duration of symptoms • What has helped so far
Body temperature for Fever is?
> 38°c
Infection Signs or clinical test WCC?
White Cell Count Will Increase during infection
what is ↑ CRP during infection?
C reactive protein Increase
How to diagnose the sign of symptoms of infection?
Cultures (e.g. urine, stool, sputum)
Sputum mean a (mixture of saliva and mucus coughed up from the respiratory tract)
What is positive culture?
Taking a swab Growing in your agar plates and identify the specific pathogen
What are the Risk factors for infection?
- Recent surgery/procedures?
- Immunosuppressed? (Medication, HIV)
- Co-morbidities? (eg; Diabetes)
- Recent exposure to infected individuals or sources of infection? (eg: contact tracing in COVID-19 pandemic)
- Vaccination status?
What are the Probable Sources of infection?
Endogenous infections:(Which is remain inside the body) E. coli UTI
Staph aureus skin infections (e.g. infected IV lines)
Exogenous infections mean?
Person-person, animal-person, Ex: Influenza, COVID-19, HIV (person to person)
Is the Common Cold (Viral) or Bacterial?
(Viral) So, manage symptoms
Is the Otitis Media (inflammatory diseases) of the middle ear bacterial or Viral?
Often Viral so Manage symptoms
Is the Conjunctivitis viral or bacterial?
Both
What is Asymptomatic UTI Viral or Bacterial?
Bacterial (Do not treat)
Is the Sinusitis viral or bacterial?
(Bacterial): Treat if fever present
Initiating Antimicrobial treatment what consideration I should do?
Patient symptoms (swelling, erythema) Tests results (temperature, BP, HR) Risk factors for infection (broken skin) Suspected source Antimicrobial treatment needed? Culture /swab/viral PCR Begin empiric therapy
What is Empiric Therapy?
It is a therapy, based on experience Or on the basis of a clinical “educated guess” in the absence of complete or perfect information.”
Guidelines for Empiric therapy for different DHBs?
- BPAC Antibiotic Guide
- SCRIPT (ADHB)
- EMPIRIC (CCDHB)
- Pink Book (CDHB)
- Starship (Children’s Hospital ADHB)
- Micro guide (SDHB)
Apply our JUDGEMENT before applying Empiric Therapy: 3 factors need to consider: Bug, Drug, Patient?
- Infection factors (Bug)
• Organism
• Severity of infection: Systemic? Localised? - Antimicrobial factors (Drug)
Spectrum of activity (broad vs narrow) • PK/PD: Distribution, Half life
• Toxicity and ADR profile (risk/benefit) • Local sensitivities
• Formulations available • Funding considerations
3. Patient factors • Allergy status • Age – neonates, elderly • Renal function • Hepatic function • Co-morbidities (including immunosuppression) • Pregnancy/Breastfeeding • Previous antimicrobial exposure • Drug interactions • Clinical setting: inpatient/outpatient • Site of infection: eg: CNS infection vs eye infection
Why we need to Narrow the antimicrobial spectrum?
Reduce the risk of antimicrobial resistance (AMR) and improves efficacy by selecting therapy that targets specific infective organisms
Patient is clinically improving (IF NOT, aim for broader coverage)
What is the monitoring after empiric therapy apply?
1. Clinical improvement (Patient) • Symptoms (local and systemic) • Observations (HR, RR etc) • Physical exam (chest sounds, abdomen exam) • Bloods (CRP, WCC) • Imaging (CXR) • Possible new-onset ADRs (drug safety) 2. Therapeutic Drug Monitoring (Drug) • Serum levels • MIC-Time dependant killing • Cmax-Concentration dependant killing
What would be the Duration of Treatment for Empiric therapy?
Most common infections have a standard treatment regimen
• Refer to local guidelines
Guidelines typically provide a range. This requires the use of clinical judgement.
• Severity of infection • Location of infection • Drug tolerability
What we will do if Empiric Treatment Fail to treat infection?
- We will check about the empiric therapy appropriate.
- Appropriate spectrum for suspected organism
- Dose and frequency: PKPD factors for individual patients.
- Removed any contributing factors? (catheters, drains, central lines, wound debridement).
- Was it truly an infection
- Is there a possibility of re-infection
- Was the patient compliant
- Antimicrobial resistance
- Review cultures
Antimicrobial guidelines are guides?
To assist provision of patient care.
Where Clinical judgement and patient cantered care must be applied.
There is no one size fit all.
What if non-compliance apparent what are they?
Pill burden
Dose frequency
Special instructions
Intolerance etc
