Management of common infections

Question 1

What does antibiotic stewardship mean?

Answer 1

Sensible antibiotic prescribing (often with guidelines)

Question 2

Why is antibiotic stewardship important?

Answer 2

• Antibiotic resistance
• Adverse effects of antibiotics
• Antibiotic cost (and cost of side-effects)

Question 3

Why has antibiotic resistance arisen

Answer 3

• Injudicious use of antibiotics (hospitals, GPs and argiculture)
• Inherent property of micro-organisms (easily able tospread genes)
• Lack of investment from big pharma (as soon as a new antibiotic is released it has to be tightly regulated)

Question 4

What percentage of patients suffer from adverse effects from antibiotics?

Answer 4

~ 20% (includes allergy, side-effects, C diff)

Question 5

What may fever and elevated CRP indicate other than infection?

Answer 5

• Pancreatitis
• Drug fever
• Malignancy
• Blood in the wrong place (thrombus or haemorrhage)

Question 6

Why if a bug is grown in the lab may the patient sometimes not be treated?

Answer 6

• The bug may not be causing any damage - may just be part of normal flora
• Have to ensure it is a decent sample (pus as opposed to swab) and not contaminated

Question 7

What does uni pus, ibi evacua refer to?

Answer 7

• Where there’s pus, let it out
• Also if there is a foreign body causing infection, remove it
• If there is non-viable tissue, debride it

Question 8

What factors must you consider when considering the correct length of time to presrcibe the antibiotic?

Answer 8

• How well does the antibiotic penetrate the target tissue
• How rapidly does the microorgansim multiply
• Guide by progress

Question 9

What are some of the factors that could be the reason for a patient to not respond to the antibiotic?

Answer 9

• Is it the right antibiotic (resistance, re-culture)
• Is the antibiotic getting where it needs to go
• Is the antibiotic being presrbed at the right dose
• Is it being administered via the corret route
• Has ‘source control’ been achieved (remove bulk of infection e.g drain pus, remove prosthesis)
• Is the problem really an infection

Question 10

When is combination therapy useful?

Answer 10

• Emperic abx (cover more bases)
• Synergistic abx (e.g gentamycin with Beta lactam in strep IE)
• To prevent resistance (TB, HIV, S. aureus)
• Mixed infection

Question 11

What are the 3 main causes of pyrexia of unkown origin?

Answer 11

• Infections
• Malignancies
• Connective tissue disease

Question 12

Causes of PUO

Answer 12

Picture

Question 13

Prognosis for patients with PUO?

Answer 13

• 70% get better
• 25-30% have on-going symptoms
• ~ 3%