Patient Needs

Question 1

What are signs and symptoms of an infection?

Answer 1

Fever/malaise
Aches/pains
Pus swelling or inflammation
drowsiness in children
Confusion in elderly
worsening renal function

Question 2

What are clinical markers of infection?

Answer 2

Low BP
Raised BG
High:
-ESR
-C-reactive protein
-temperature
-resp rate
-pulse

Question 3

What is antimicrobial stewardship defined as?

Answer 3

An organisation or healthcare system wide approach to promoting and monitoring the judicious use of antimicrobials to preserve future effectiveness.

Question 4

What are Antibiotic principles

Answer 4

Avoid blind prescribing

-Don’t treat virals w/ Abx

-Narrow spectrum are
preferred except from serious infections where broad spectrum is needed

-Avoid prolonged therapy and complete courses

• Follow national and local prescribing guidelines

-Dose varies according to patient factors.

Question 5

What dose choice of antibiotic depend on?

Answer 5

Causative agent
Patient

Question 6

What are increased risks and contradictions for children and elderly when prescribing Abx?

Answer 6

Children- Tetracyclines contraindicated in <12 yrs
Quinolones cause arthropathy-avoided

Elderly- increased risk of C.diff infection (Clindamycin has highest risk)
Renal and liver impairment.

Question 7

What Abx would you avoid or prescribe with caution in:

-Renal impairment
-hepatic impairment

Answer 7

Renal:
tetracyclines
nitrofurantoin (eGFR <45)

Hepatic:
rifampicin, tetracyclines
reduce metronidazole dose if severely impaired.

Fluclox and co-amox cause cholestatic jaundice

Question 8

What Abx would you avoid or prescribe with caution in pregnancy?

Answer 8

Pregnancy:
contraindicated: tetracyclines
trimethoprim

Nitrofurantoin: causes nausea, avoid at term

Avoid: MCAT
(Metronidazole, Chloramphenicol, Aminoglycosides, Tetra)

Question 9

What are the safest antibiotics in pregnancy?

Answer 9

penicillins
cephalosporins

Question 10

What side effects can Abx cause?

Answer 10

GI:
n+v, diarrhoea, abdominal pain

Superinfection:
Clindamycine and broad spectrum Abx kill normal flora and allow selective organisms to thrive; causing Abc-associated colonies and thrush.

Allergic reaction:
1 in 15 experience to penicillins and cephalosporins.

Question 11

Generally what antibiotic would be used against what microorganism?

Answer 11

Staphy-fluclox

MRSA- vancomycin

strep- phenoxy

anaerobic bacteria- Metronidazole

Pseudomonas Aeruginosa-gentamicin