Empirical Antibiotic Policies Flashcards
Which bacteria are the most common cause of throat infections?
Group A Strep - causes strawberry tongue (enlarged papillae)
What is the definition of sepsis?
Life-threatening organ dysfunction which occurs as a result of a dysregulated host response to infection
- quantified by an increase in the sequential organ failure assessment (SOFA) score of 2 or more for the organ in question
- or quick SOFA - confusion, hypotension or tachypnoea
What is the definition of septic shock?
Sepsis plus hypotension resistant to intravascular volume replacement and usually lacticacidosis
- altered tissue perfusion
What are the sepsis six in regards to treating sepsis?
- all to be performed within 1 hour to sepsis being recognised
Perform blood cultures and/or other bacteriology
Antibiotic administration
- in the clinical area where sepsis was diagnosed
- notify antibiotic administrator - to prevent delay in administration
- prescribe in once only
- record indication/suspected site/source of infection
High flow oxygen - because they are probably underperfusing tissues (ventilation-perfusion mismatch)
Measure lactate and heamoglobin
IV fluids
Monitor urinary output
In regards to sepsis, what things increase the mortality rate?
Increasing lactate levels
Delay in the treatment of the antibiotics
Why isn’t penicillin given orally for severe infections is hospitals?
It is inactivated by stomach acid - is ineffective
If you are not sure of the causative organism, what should be always be given?
IV Clinadmycin - gram negative cover (suppresses toxin production)
What are the indications of IV therapy?
Sepsis syndrome, SIRS or rapidly progressing infection
Special conditions
- infective endocarditis
- CNS infection - need to get antibiotics against the blood brain barrier
- S.Aureus bacteraemia
- osteomyelitis
Moderate-severe skin and soft tissue infections
Infections that compromise the oral route
No oral formulation of antibiotic available
What bacteria cause cellulitis?
Strep pyogenes and betahaemolytic streps A, B, C or G (group A is most common cause)
Staph aureus (10%) - well defined red rash (MSSA not MRSA)
- most common cause of wound infections in hospitals
Gram negatives are possible, but very uncommon
What is the treatment for cellulitis?
Flucloxacillin IV - continued until there is clinical improvement
- covers staph and strep
In very severe cases you can add IV Clarithromycin
Which bacteria are the causative organisms of Necrotising fascitis?
Group A strep (sometimes B, C and G as well)
Can be caused by staph aureus, but really uncommon
Rarely caused by gram negative organisms
What is the treatment for necrotising fasciitis?
Antibiotics don’t work
Debridement surgery is necessary - and sometimes limb amputation
- radical surgery
Clindamycin is given to turn off toxin production
What is the EAGLE effect in necrotising fasciitis?
The static growth phase with excess toxin production, saturating PCP binding sites (beta-lactams are not effective here)
- saturation
What is the treatment for meningitis?
5-7 days of Ceftriaxone or Benzyl penicillin
- very susceptible to penicillin
- Ceftriaxone is very good at penetrating the blood brain barrier
If the causative organism of an infection is unknown, what antibiotics are given?
Gentamicin - gram negative cover
Flucloxacillin- staph aureus cover
Benzyl-penicillin - pneumococcus cover
