Clinical use of antimicrobials (DONE) Flashcards
How do you identify infection?
Temperature
Site specific response
Blood tests: CRP, ESR (erythrocyte sedimentation rate), WCC
How do we treat infection?
Symptomatic treatment- paracetamol
Support the immune system- nutrition, keep warm
Give it something to kill the pathogen or stop it growing
Why use guidelines?
Maximise chance of successful treatment
Reflect local patterns of sensitivity
Advice on doses, course lengths, route, monitoring etc.
Minimise bad practice
Limitations of guidelines
Underlying lung disease e.g. bronchiectasis, COPD
Aspiration- GI tract contents into lungs
Hospital acquired infections- often non-socomial pneumonias
Cultures
Sample of blood, urine or swab
C&S: culture and sensitivity
Take before any antibiotics given
Provides ID of organisms (48 hours) and sensitivities (at least 5 days or longer)
Sensitivities
Can take at least 5 days
Most labs will test for a wide range of antibiotics
Will only report a small selection
Aims: reduce resistance, reduce C. difficile, save stronger antibiotics
Common infections (community)
Upper respiratory tract infection (URTI)
Lower respiratory tract infection (LRTI)
Urinary tract infection (UTI)
URTIs
Common cold, acute sinusitis, influenza, sore throat, otitis media, tonsillitis
Likely viral, low severity, unlikely to benefit from antibiotics
Otitis media
Common in children (especially after a cold)
No distinguishing features between bacterial and viral
60% resolve within 24 hours without antibiotics
Treatment: symptomatic, antibiotics may be considered if bilateral, bulging membranes, discharge
LRTI
Likely to be acute exacerbation of COPD or community acquired pneumonia
More likely to be bacterial, more severe illnesses, benefit from antibiotics
Pneumonia symptoms
Dry or productive cough Difficulty breathing Rapid heartbeat Fever Feeling generally unwell Sweating and shivering Loss of appetite Chest pain
Pneumonia treatment
Paracetamol/ibuprofen, fluids, stop smoking, avoid cough medicines
Amoxicillin, doxycycline, clarithromycin
CURB-65
Confusion Urea Respiratory rate >30/min BP systolic <90mmHg Age >65
Amoxicillin for pneumonia
Active against the main causative organisms
Distributed into lung tissue
Well tolerated
Convenient to administer
Counselling CAP patients
Symptoms should improve after starting treatment
1 week- fever should resolve
4 weeks- chest pain and sputum production should have substantially reduced
6 weeks- cough and breathlessness should reduce
3 months- most symptoms should resolve but fatigue may still be present
UTI symptoms
Frequency Urgency Dysuria Suprapubic discomfort Polyuria Haematuria
Complicated UTI
Pregnant Male Children Elderly Impaired renal function
UTI treatment
Trimethoprim- caution in pregnancy, blood dyscrasias
Nitrofurantoin- renal impairment
Amoxicillin- penicillin allergy
Cephalosporin- cross resistance to penicillin
Antibiotic side effects
Gentamicin- renal toxicity Rifampicin- orange urine Ciprofloxacin- pre-disposure to seizures Nitrofurantoin- confusion in elderly Tetracycline- discolouration of teeth
Hospital infections
More serious
Need IV treatment
Developed in hospital
Different organisms involved
Role of pharmacist
Appropriate drug choice (dose and route) Allergies Interactions Contraindications Follow up C&S results Monitor progress Monitor duration Patient education Audit
Resistance
Makes diseases more difficult to treat and prevent
Increase length and severity of disease
Increase spread of disease
Affect diagnostic techniques
Use of alternative with lesser known safety profiles
Financial implications
HAP treatment
Most likely organisms: S. aureus, Klebsiella, Pseudomonas
Treatment: sputum culture, piperacillin/tazobactam, meropenem
MRSA
Resistance due to overuse of methicillin
Healthy people often carriers- nose, throat, perineum
Vulnerable patients become infected
MRSA treatment
Vancomycin, teicoplanin, rifampicin, trimethoprim, sodium fusidate
Combinations used to prevent further resistance
Isolate patients
Infection control procedures
Decolonisation
C. difficile
Anaerobic bacteria in large intestine
Diarrhoea
Most at risk: recently had broad spectrum antibiotics, other underlying illnesses
Spread through faeces (airborne spores)
C. difficile treatment
Reduce unnecessary antibiotics Isolate patient Cleaning and hand washing technique Medication review- PPIs, laxatives Treatment- metronidazole, oral vancomycin
Meningitis
Bacterial or viral
Symptoms: high temperature, vomiting, severe headache, neck stiffness, photophobia, blotchy red rash
Organisms: N. meningitides, Strep. pneumonia, H. influenzae
Prophylaxis
Surgery: open wounds- high infection risk, contamination- gut contents, surgical team, consequence of infection- high in bones
Depends on type of surgery, most likely pathogens and guidelines
