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management of infection > Lecture 21 - Antibiotic Use > Flashcards

Lecture 21 - Antibiotic Use Flashcards

1
Q

Where does antibiotic use occur?

A

20% in hospital and 80% in primary care

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2
Q

What % of hospital pharmacy budget are antimicrobials?

A

30%

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3
Q

What % of antibiotic prescriptions are inappropriate?

A

20-50%

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4
Q

What is considered a healthcare associated infection?

A

an infection which occurs in a patient who has been in hospital >48 hours

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5
Q

What does antibiotic use increase?

A

the likelihood of HAI, especially in those over 65§

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6
Q

What is the current HAI threat?

A

E coli, which originates from UTI and can lead to bacteraemia

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7
Q

What is the main issue of antibiotic use?

A

the use of antibiotics for self liming infections caused by viruses or in some case bacteria

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8
Q

What are the 5R’s of antibiotic use?

A

right choice

right dose

right frequency

right route

right duration

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9
Q

Antibiotic use for lower UTI in female?

A

community

trimethoprim 200mg twice daily orally for 3 days

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10
Q

Antibiotic use in severe community acquired pneumonia in hospital?

A

amoxicillin 500mg 3x daily IV for 5 days
+
clarithromycin 500mg 2x daily IV/oral for 5 days

review daily

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11
Q

Management of URTI?

A

usually self limiting do don’t need antibiotics

community pharmacists give advice on symptoms relief

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12
Q

What are prescribing strategies?

A

no prescription

delayed prescription

immediate prescription

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13
Q

Acute otitis media duration?

A

(ear ache)

4 days

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14
Q

Acute sore throat/pharyngitis/tonsilitis duration?

A

1 week

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15
Q

Common cold duration?

A

1 and a half weeks

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16
Q

Acute sinusitis duration?

A

2 and a half weeks

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17
Q

Acute cough/bronchitis duration?

A

3 weeks

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18
Q

How will a sore throat without antibiotics resolve?

A

40% in 3 days and 90% after 7 days

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19
Q

Antibiotics use in acute cough?

A

reduce symptoms by only one day in an illness lasting up to 3 weeks

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20
Q

Antibiotics in otitis media?

A

66% of children are better within 24 hours and antibiotics have no effect on symptoms

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21
Q

Adverse reactions of antibiotics occurance?

A

1 in 16 patients

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22
Q

Side effects of antibiotics?

A

GI effects such as nausea, vomiting and diarrhoea

serious rashes and skin reactions as well as C difficile infection

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23
Q

What are patients prescribed an antibiotic in primary care for a respiratory infection at risk of?

A

infection with bacteria resistant to that antibiotic which may persist for up to 12 months

24
Q

When are antibiotics required to treat URTI?

A

symptomatically very unwell - fever/chills, low blood pressure, fast heart rate or breathing

symptoms of serious complications e.g. pneumonia

25
Q

Patients at high risk of serious complications?

A

> 65 years with acute cough and 2 of the following (or >80 years and one symptom)

hospitilisation in previous year

diabetic

cardiac failure

26
Q

When to treat specific URTI?

A

bilateral acute otitis media in children <2 years

acute sore throat/pharyngitis/tonsilitis using fever pain

27
Q

What is feverpain?

A

fever in the past 24 hours

pus on tonsil s

attends rapidly (within 3 days)

inflamed tonsils

no cough or cold symptoms

28
Q

What does a feverpain score of 4 or 5 suggest?

A

high chance of streptococcal infection

29
Q

When to use antibiotics for other infections?

A

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

30
Q

What might blood pressure be in a severe infection?

A

low

31
Q

What should be advised to patients for symptom relief?

A

fluids, rest, simple analgesia (paracetamol or ibuprofen)

32
Q

What are the two key elements used to promote appropriate antibiotic use?

A

guidance/policies for clinicians on use of antibiotics

education of healthcare staff, patients and public

33
Q

What do antimicrobial prescribing guidelines give?

A

evidence based guidance on empirical treatment of common infections

34
Q

What do antimicrobial prescribing guidelines promote?

A

use of narrow spectrum agents and restrict broad spectrum agents and those associated with high risk of C difficile infection

35
Q

What is most antibiotic therapy?

A

empirical - best guess at likely infecting organism

36
Q

What is empirical therapy usually?

A

broad spectrum

37
Q

When should directed antibiotic therapy be used?

A

if you know the causative organism

38
Q

What are the most common types of infection in hospital and primary care?

A

respiratory - URTI, exacerbation COPD, pneumonia

urinary - lower, upper (pyelonephritis)

skin & soft tissue - cellulitis, wound infection, diabetic ulcer

39
Q

What does the severity of the infection indicate?

A

where it is managed

GPs have clear criteria for when to refer to hospital

40
Q

What are there other policies for in hospitals?

A

surgical prophylaxis

IV to oral switch (IVOST)

protected/alert antibiotics

specialist unit policies e.g. haematology, renal

gentamicin and vancomycin

41
Q

Who should be trained in antimicrobial stewardship?

A

all staff who prescribe, monitor or administer antimicrobial therapy

42
Q

How is education for healthcare staff done?

A

hospital based induction sessions for new staff

GP practice based education for GPs and other prescribers

public education is also important

43
Q

How is pharmacist training and education done?

A

pre-registration training

specialist training

NES hosted learning sessions aimed at community pharmacists delivered in every NHS board

2018-19 training hosted by RPS

44
Q

What kind of specialist training do pharmacists get?

A

antimicrobial pharmacist intensive training

pharmacokinetics of gentamicin and vancomyin training

45
Q

Nursing staff educational acitivities?

A

TDM antibiotics, IVOST poly, Alert Antibiotics

46
Q

Medical staff education activities?

A

safer use of TDM antibiotics, antibiotic policies

47
Q

Hospital pharmacy staff educational activities?

A

alert antibiotics, MRSA eradication, hand hygiene, audit results

48
Q

Why measure things?

A

Lord Kelvin - to measure is to know

to improve something you need to measure it

49
Q

What are antimicrobial resistance trends?

A

Show resistance to key antibiotics in common pathogenic organisms monitored

50
Q

What do samples from microbiology labs in hospitals generate?

A

reports which are collated at local and national level

also monitor for new resistance emerging in alert organisms

51
Q

What are a major emerging threat?

A

multi resistant gram negative organisms

52
Q

How are MRGN spread?

A

international travel, particularly medical tourism

53
Q

What can resistant strains of E coli or klebsiella cause?

A

bacteraemia, UTI, intra-abdominal infection os respiratory tract infection

54
Q

What is the latest threat?

A

carbapenemase producing enterobacteriaceae

55
Q

What are diagnostics?

A

major changes in time for identification of bacteria and sensitivity to antibiotics

whole genome sequencing

point of care tests

56
Q

What is the role of prescribers in antibiotic use?

A

nurses and pharmacists have increasing role

57
Q

Covid-19 antibiotic use?

A

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

management of infection (36 decks)

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