Chapter 5: Infections Flashcards
What is antibiotic stewardship?
Organisational or healthcare system wide approach to promoting and monitoring judicious use of antimicrobials to persevere their future effectiveness.
What is the difference between antibiotic and antimicrobial resistance?
Antibiotics resistance: resistance to ABX that occurs in common bacteria that cause infections.
Antimicrobial resistance: broaden term including resistance to drugs to treat infections caused by other microbes including parasites (e.g. malaria), viruses (e.g. HIV) and fungi (eg candida), Protozoa
What is antimicrobial resistance?
The ability of microorganisms to become increasingly resistance to a antimicrobial agent to which they were previous susceptible.
AMR is a consequence of genetic mutation and natural selection.
Such mutation is then passed on conferring resistance.
AMR cannot be eradicated but managed to limit their impact on health
What are the main causes of AMR?
Availability of antibacterials without a Rx in some countries.
Patient demand for antibacterials for inappropriate infection.
Failure of patients to complete their prescribed course of antibacterials.
Overuse and misuse of antibacterials in humans, animals and agriculture.
How can pharmacist help with AMR?
- Improving infection prevention control.
- Making sure the right antibacterial is given for the right clinical indication, at the right dose, right time, right direction, right route and duration.
- when there is clinical uncertainty about a condition, back up or delayed prescribing can be used to offer an alternative to immediate prescribing.
- by checking that antibiotics and other antimicrobials are prescribed when needed, comply with local guidance and query if not so.
- don’t prescribe for self limiting conditions.
- give patient clear advice including the duration, frequency, dose, potential SEs and return unused antibacterials to the pharmacy.
- by providing information on self limiting infections, use PILs to explain duration and how to treat the symptoms.
List self limiting conditions?
Common cold Acute otitis media Acute cough Acute bronchitis Acute sore throat Acute pharyngitis Acute tonsillitis Acute rhionsinuitis
What should be considered before treating antibiotics?
- Avoid blind therapy
- Take samples for culture and sensitivity testing
- Use narrow spectrum abx when possible
- Avoid prolonged use of abx: can lead to SEs, encourage resistance and are costly.
- Limit telephone prescribing to exceptional cases
- always check for allergies
- for immunocompromised patient: start treatment immediately.
What is superinfection?
- An infection caused by an infection.
- Broad spec antibacterials are more likely to cause side effect, eg.g Abx associated colitis, fungal infections and vaginitis, pruritus ani (itchy bum)
When should a Doctor notify the proper officer of suspected cases of notifiable diseases?
- Complete and send notification form and send within 3 days
- Verbal notification (phone, letter, e-mail, secure fax): within 24 hours for urgent cases
List examples of notifiable diseases?
Food poisoning Infectious bloody diarrhoea TB Plague Meningococcal septicaemia Scarlet fever Smallpox Whooping cough (pertussis) Meningitis Acute encephalitis
What is the difference between sepsis and septicaemia?
Sepsis: infection of the whole body
Septicaemia: blood infection
How soon should treatment for sepsis be started and monitored?
- ASAP, ideally within 1 hour
- monitor every 30 mins
What are the 6 main signs and symptoms of sepsis?
- Higher RR (normal: 12-20 breaths per min)
- Higher or low HR (normal: 60-100 bpm)
- Lower O2 stats (normal: 95-100%)
- Systolic BP < or = to 90mmHg if age 12 and above
- Higher or lower Temperature (normal 36.1-37.2 degrees)
- Reduced Consciousness/confusion
What are the additional signs and symptoms of sepsis?
- Lactate levels 2mmol/L or above
- Non blanching, mottled/ashen or cyanotic skin rash (like meningitis)
- Not passed urine/dehydration
- Infection, fever, cold and shivers
What additional signs and symptoms are seen in children and babies in sepsis?
Feel abnormally cold to touch Has a fit or convulsion No wet nappies for 12 hours or more No interest in feeding Soft spot on baby’s head is bulging Weak whining or continuous crying
What is sepsis 6?
It’s the recommendations for the early management of sepsis.
- 3 tests:
1. blood cultures immediately before treatment
2. Blood sample to assess severity
3. Monitor urine output to assess kidney damage (AKI)
3 Treatments:
- IV broad spec abx (within 1 hour of admission)
- IV fluids (within 1 hour of admission)
- O2 to counteract lactate if needed to keep stats over 94%
(Give vasopressors and inotropes e.g. DA and adrenaline to improve BP if needed)
What future tests can be conducted in sepsis?
FBC: WBC, C reactive protein, lactate Clotting factors, D- dimer (linked to blood clots) Chest x-ray Urine analysis CT scan (meningitis)
What are the risk factors of sepsis?
Very young and old
Immunocompromised patients (HIV, cancer, patients on steroids and diabetics, and transplant patients)
Pregnancy
IV drug misusers
What is given for rheumatic fever prevention?
Pen(V)
Or Sulfadiazine
What is given for pertussis prophylaxis?
CLARITHYROMYCIN ‘ACE’
What is given for pneumococcal infection in aslpenia or in patients with sickle cell disease prophylaxis?
Pen v adult: 250mg BD
If pen allergic: erythromycin
What is given for ANIMAL and human bites prophylaxis?
Co-amoxiclav alone (375-625mg TDS) up to 5-7 days
Pen allergic: (doxycycline 100mg BD+ metronidazole 400mg TDS)
What is given for community and hospital acquired septicaemia?
A broad spec antipseudomonal penicillin:
1. Piperacillin/tazobactam
Or broad spec cephalosporin e.g. cefuroxime
(Hospital alternative: meropenem or cilstatin and imipenem)
MRSA suspected: add vancomycin or teicoplanin
If anaerobic suspected: add metronidazole to broad spec cephalosporin.
What is given for meningococcal septicaemia ?
Single dose of IV Pen G. Give before urgent admission to hospital.
Pen allergy alternative: IV Cefuotaxime
If hypersensitivity to pen and cephalosporins: IV Chloramphenicol