Lecture 21 - Antibiotic Use Flashcards
Where does antibiotic use occur?
20% in hospital and 80% in primary care
What % of hospital pharmacy budget are antimicrobials?
30%
What % of antibiotic prescriptions are inappropriate?
20-50%
What is considered a healthcare associated infection?
an infection which occurs in a patient who has been in hospital >48 hours
What does antibiotic use increase?
the likelihood of HAI, especially in those over 65§
What is the current HAI threat?
E coli, which originates from UTI and can lead to bacteraemia
What is the main issue of antibiotic use?
the use of antibiotics for self liming infections caused by viruses or in some case bacteria
What are the 5R’s of antibiotic use?
right choice
right dose
right frequency
right route
right duration
Antibiotic use for lower UTI in female?
community
trimethoprim 200mg twice daily orally for 3 days
Antibiotic use in severe community acquired pneumonia in hospital?
amoxicillin 500mg 3x daily IV for 5 days
+
clarithromycin 500mg 2x daily IV/oral for 5 days
review daily
Management of URTI?
usually self limiting do don’t need antibiotics
community pharmacists give advice on symptoms relief
What are prescribing strategies?
no prescription
delayed prescription
immediate prescription
Acute otitis media duration?
(ear ache)
4 days
Acute sore throat/pharyngitis/tonsilitis duration?
1 week
Common cold duration?
1 and a half weeks
Acute sinusitis duration?
2 and a half weeks
Acute cough/bronchitis duration?
3 weeks
How will a sore throat without antibiotics resolve?
40% in 3 days and 90% after 7 days
Antibiotics use in acute cough?
reduce symptoms by only one day in an illness lasting up to 3 weeks
Antibiotics in otitis media?
66% of children are better within 24 hours and antibiotics have no effect on symptoms
Adverse reactions of antibiotics occurance?
1 in 16 patients
Side effects of antibiotics?
GI effects such as nausea, vomiting and diarrhoea
serious rashes and skin reactions as well as C difficile infection
What are patients prescribed an antibiotic in primary care for a respiratory infection at risk of?
infection with bacteria resistant to that antibiotic which may persist for up to 12 months
When are antibiotics required to treat URTI?
symptomatically very unwell - fever/chills, low blood pressure, fast heart rate or breathing
symptoms of serious complications e.g. pneumonia
Patients at high risk of serious complications?
> 65 years with acute cough and 2 of the following (or >80 years and one symptom)
hospitilisation in previous year
diabetic
cardiac failure
When to treat specific URTI?
bilateral acute otitis media in children <2 years
acute sore throat/pharyngitis/tonsilitis using fever pain
What is feverpain?
fever in the past 24 hours
pus on tonsil s
attends rapidly (within 3 days)
inflamed tonsils
no cough or cold symptoms
What does a feverpain score of 4 or 5 suggest?
high chance of streptococcal infection
When to use antibiotics for other infections?
when there are clear signs of infection such as
raised temperature
raised blood pressure and/or heart rate
increased respiratory rate - chest infection
pain, redness, swelling, skin infection
What might blood pressure be in a severe infection?
low
What should be advised to patients for symptom relief?
fluids, rest, simple analgesia (paracetamol or ibuprofen)
What are the two key elements used to promote appropriate antibiotic use?
guidance/policies for clinicians on use of antibiotics
education of healthcare staff, patients and public
What do antimicrobial prescribing guidelines give?
evidence based guidance on empirical treatment of common infections
What do antimicrobial prescribing guidelines promote?
use of narrow spectrum agents and restrict broad spectrum agents and those associated with high risk of C difficile infection
What is most antibiotic therapy?
empirical - best guess at likely infecting organism
What is empirical therapy usually?
broad spectrum
When should directed antibiotic therapy be used?
if you know the causative organism
What are the most common types of infection in hospital and primary care?
respiratory - URTI, exacerbation COPD, pneumonia
urinary - lower, upper (pyelonephritis)
skin & soft tissue - cellulitis, wound infection, diabetic ulcer
What does the severity of the infection indicate?
where it is managed
GPs have clear criteria for when to refer to hospital
What are there other policies for in hospitals?
surgical prophylaxis
IV to oral switch (IVOST)
protected/alert antibiotics
specialist unit policies e.g. haematology, renal
gentamicin and vancomycin
Who should be trained in antimicrobial stewardship?
all staff who prescribe, monitor or administer antimicrobial therapy
How is education for healthcare staff done?
hospital based induction sessions for new staff
GP practice based education for GPs and other prescribers
public education is also important
How is pharmacist training and education done?
pre-registration training
specialist training
NES hosted learning sessions aimed at community pharmacists delivered in every NHS board
2018-19 training hosted by RPS
What kind of specialist training do pharmacists get?
antimicrobial pharmacist intensive training
pharmacokinetics of gentamicin and vancomyin training
Nursing staff educational acitivities?
TDM antibiotics, IVOST poly, Alert Antibiotics
Medical staff education activities?
safer use of TDM antibiotics, antibiotic policies
Hospital pharmacy staff educational activities?
alert antibiotics, MRSA eradication, hand hygiene, audit results
Why measure things?
Lord Kelvin - to measure is to know
to improve something you need to measure it
What are antimicrobial resistance trends?
Show resistance to key antibiotics in common pathogenic organisms monitored
What do samples from microbiology labs in hospitals generate?
reports which are collated at local and national level
also monitor for new resistance emerging in alert organisms
What are a major emerging threat?
multi resistant gram negative organisms
How are MRGN spread?
international travel, particularly medical tourism
What can resistant strains of E coli or klebsiella cause?
bacteraemia, UTI, intra-abdominal infection os respiratory tract infection
What is the latest threat?
carbapenemase producing enterobacteriaceae
What are diagnostics?
major changes in time for identification of bacteria and sensitivity to antibiotics
whole genome sequencing
point of care tests
What is the role of prescribers in antibiotic use?
nurses and pharmacists have increasing role
Covid-19 antibiotic use?
is a viral illness which for most patients is a mild, self limiting infection
empirical antibiotic therapy if required for suspected bacterial infection should be used in line with routine guidelines
