Infections: Patients needs Flashcards
intro to infections and antimicrobial stewardship
what are the signs and symptoms of infection?
fever, malaise, aches, and pains pus, swelling, or inflammation drowsiness in children confusion in elderly worsening renal function
Clinical markers:
Low blood pressure
raised blood glucose
High ESR, C-reactive protein, temperature, respiratory rate, and pulse
What is ESR?
The erythrocyte sedimentation rate is the rate at which red blood cells in anticoagulated whole blood descend in a standardized tube over a period of one hour. It is a common hematology test, and is a non-specific measure of inflammation
define antimicrobial stewardship
organizational/ Healthcare system approach to promoting and monitoring the judicious use of antimicrobials to preserve future effectiveness
Principles of antimicrobial stewardship?
Don’t treat viral infections with antibiotics
avoid blind prescribing
narrow-spectrum antibiotics are preferred except for serious infections where broad-spectrum are required
avoid prolonged therapy and always finish courses
the dose varies depending on patient factors
prescribed for oral infections on the basis of defined need
what does the choice of antibiotic depend on
the patient
the causative agent
what needs to be considered when prescribing antibiotics for children
Children: tetracyclines e.g. doxycycline are contraindicated in children under 12
quinolones e.g. ciprofloxacin can cause arthopathy (disease of the joints) and should be avoided
what needs to be considered for the following patient factors : elderly
There is an increased risk of Clostridium Difficile infection in the group and the risk is greatest with clindamycin
Renal and liver impairment and drug interactions
what needs to be considered for the following patient factors?
allergies
Penicillin allergies - check for cross sensitivities with cephalosporins and other beta-lactam antibiotics
alternatives in penicillin-allergic patients:
macrolides (e.g. erythromycin)
metronidazole in dental infections
what needs to be considered for the following patient factors?
renal impairment
Nephrotoxicity caused by aminoglycosides glycopeptides
avoid giving tetracyclines (except minocycline and doxycycline )
avoid giving nitrofurantoin if eGFR<45
what needs to be considered for the following patient factors?
hepatic impairment
Rifampacin and tetracyclines can cause hepatoxicity
Reduce metronidazole dose in severe impairment
cholestatic jaundice can occur if co-amoxiclav and flucloxacillin are given
what needs to be considered for the following patient factors? pregnancy
tetracyclines and trimepthoprim are contrindicated
nitrofurantoin causes nausea, avoid at term
avoid MCAT : Metranidazole, chloramphenicol,aminoglycosides, tetracyclines
avoid quinalones and sulphaonamides
safest antibiotics : pencillin and cephlasporins
What is the geenral cautionary advisory label for antibiotics?
Space the doses evenly throughout the day and keep takinf this medicine until the course id finished, unless you are told to stop
what are common complaints and concerns when taking antibiotics?
Gi side effects: nausea, vomiting, diarrhoea and abdominal pain
risk of superinfection: clindamycin and Broad spectrum antibiotics kill normal flora and allow selective organisms to thrive; causing antibiotic associated colitis (C.diff), thrush (candida) e.g. vaginal thrush
Allergic reactions: around 1 in 15 people will experience hypersensitivity reactions to antibiotics, especially penicillin and cephlasporins
as a general rule of thumb what is used to treat the following infections: staphylococci MRSA Streptococci Anaerobic bacteria Pseudomonas aeruginosa
staphylococci: Flucloxacillin MRSA: Vancomycin Streptococci : Benzylpenicillin or phenoxymethylpenicillin Anaerobic bacteria: metronidazole Pseudomonas aeruginosa : Gentamicin
