Infection prescribing Flashcards
How do we diagnose an infection?
Physical examination:
- Hot to the touch
- Swollen
- Raised
- Black or red coloured.
- Temperature raised/spiking
- RR high
Test results:
- WCC raised
- Raised CRP - infection and inflammation.
- Cultures
Scans/Xrays:
- X ray of lungs.
- MRI scans.
What is the CURB65 tool?
Helps to determine how severe CAP is. Confusion Urea >7mmol/l RR >30/min BP low, SBP<90, DBP<60. 65: are they over 65.
What does the CURB65 tool take into account?
Confusion Urea >7mmol/l RR >30/min BP low, SBP<90, DBP<60. 65: are they over 65.
A urea result of higher than what would result in 1 point from CURB65?
Confusion Urea >7mmol/l RR >30/min BP low, SBP<90, DBP<60. 65: are they over 65.
RR of higher than what is 1 point in CURB65?
Confusion Urea >7mmol/l RR >30/min BP low, SBP<90, DBP<60. 65: are they over 65.
BP values of what are 1 point in CURB65?
Confusion Urea >7mmol/l RR >30/min BP low, SBP<90, DBP<60. 65: are they over 65.
What does the PEDIS score?
The severity of the ulcers in diabetic patients.
A PEDIC score of greater than or equal to what is when a patient will typically feel very unwell?
4 or higher.
They are now systemically unwell.
What is the general treatment plan for an infection?
- Are cultures and sens availabe?
If no: start EMPIRICAL until cultures become available at which time you modify treatment.
If yes: start TARGETED therapy. If adequate response, continue until Iv->oral switch possible.
If not adequate response, ESCALATE.
When creating EMPIRICAL guidelines, what needs to be decided? [4]
- Agent(s)
- Route
- Dose
- Duration
These all depend on the nature and factors of the infection.
Cellulitus is typically caused by
Staph.
What infection factors affect the choice of antibiotics?
- Type of infection/organism
- Site of infection
- Severity of infection
- Properties of the antibiotic
- The concentrations needed to treat the infection. MIC of organism.
Why would a patient have a one off shot of gentamycin?
when they are catherterised as a one off prophylaxis againt UTI caused by E.coli.
When would a patient with CAP be started on IV antibiotics straight away?
When CURB65 >3.
How do we monitor the effectiveness of antibiotic treatment? [4]
- Physical symptoms
- Physiological parameters: BP, Temperature.
- Infective markers: CRP, WCC.
- Radiology
Which antibiotics need therapeutic drug monitoring? [3]
Vancomycin
Gentamicin
Teicoplanin - not worried about toxicity from this drug, just monitor for efficacy where as the other two we monitor for both toxicity and efficacy.
What is the most common side effect of antibiotics?
N + Vomiting.
What other side effect should we look out for?
Rashes - could indicate allergic reaction.
What impact would the presence of a deep seated infection have on choice of antibiotic agent and duration of treatment?
Need an agent known to penetrate well into tissue.
May need a longer duration of therapy to ensure adequate treatment of the infection.
What are some of the key criteria that must be met before switching from IV to oral?
Temp <37.5 deg C for 24 hours. Improving condition/stable. S + S improving. Decreasing ESR/CRP/WBC Oral formulation available. No absorption problems: Crohns, gastric surgery etc.
What are some high-risk infections which are not suitable for switching from IV/oral?
Bacteria in blood. Gangrene/soft tissue infections. Bone infections. Prosthetic related infections. Chemotherapy related infections - compromised immune system. MRSA C/diff
What patient factors migh affect the choice of therapy?
Weight Age Renal function LFT Allergy status Can they swallow? Other disease states? Other drugs which interact with antibiotic?
Why do we not use tetracyclines in children?
They end up with brown teeth - gets deposited in bone and teeth.
Why would we not use aminoglycosides in patients with renal impairment?
They are renally toxic.
