Infectious and antimicrobial stew Flashcards
therapeutics
What is antimicrobial stewardship
Promoting appropriate use of antibiotics and combatting antibiotic resistance.
What is “start smart antimicrobial stew” ?
1) Evidence of infection: history, symptoms, physcial exam, test results.
2) Asses: evidence of infection, patient risk
3) Investigate: cultures. lab tests, imaging
4) Taking into consideration: Allergies etc
5) Document: treatment regimen and plan and review dates.
should be done within 48-72 hrs
evidence, asses, investigate, prescribe, document.
What is “cares” antimicrobial steward ship ?
cease
amend
refer
extend
switch
this is for prescription reviews
When should surgical prophylaxis be done before starting surgery procedure ?
within 1 hour before the start of the procedure
normally one dose
but can be more for longer porcedures.
common interactions
Ciprofloxacin and NSAIDS: seizures
ciprofloxacin and methotrexate: toxicity
methotrexate and penicillin: toxicity
warfarin and ciprofloxacin: anticoag effect
macrolides and diuretics: hypokalaemia
sepsis signs adults:
Slurred speech
Extreme shivering
Passed no urine in a day
Severe breathlessness
Illness
Skin discolour
sepsis signs children:
-breathing fast
-convulsions
-bluish pale looking
- rash
-lethargic
- cold
General symptoms of infection
fever
chills and sweats
cough
sore throat
shortness of breath
nasal congestion
diarrhoea
vomit
headache
temperature
local symptoms of infection
uti: pain/burning when urinating
pneumoia: coughing and chest pain
infected cut: redness/pus.
example of broad spectrum antibiotics
doxycycline
Amoxicillin/clavulanic acid
azithromycin
piperacillin/tazobactam
what type of bacteria causes skin infection
staphylococcus aureus
- so can be treated with flucloxacillin
what type of bacteria causes GI infection
anaerobic bacteria
- metronidazole can be used in combo with other broad spectrum antibiotics.
What is the “then focus” bit
1) take samples for culture
2) give appropriate empirical treatment
3) receive culture results
4) change treatment as per culture and sensitivity report (focus)
what are the 5 antimicrobial prescribing decisions
1) stop- if no longer signs or symptoms
2) switch- IV to oral
3)change- ideally change to narrow spectrum
4) continue- document next review or stop date
5)OPAT (outpatient parenteral antibiotic therapy)
what does “I” mean in a S/R sensitivity report
Intermediate
falls between sensitive and resistance
what is used to treat endocarditis
penicillin and gentamicin
- penicillin induces cell wall damage, causing permeability of enterococci to aminoglycosides to increase, facilitating gentamicin to get to the target site.
example of an antagonistic combo that should not be given together
erythromycin and clindamycin
- as they both bind to the same sub unit of bacterial ribosome
- so will compete for binding site, and will have no effect.
what are examples of drugs that require therapeutic monitoring
Vancomycin
gentamicin
teicoplanin
- to make sure levels of drug is maintained within the therapeutic window.