Prescribing antibiotics, analgesics, and antifungals Flashcards
Why should we prescribe appropriately?
Inappropriate prescribing leads to ineffective and unsafe treatment, exacerbates or prolongs illnesses, and can cause distress or harm to patients.
How is treatment with prescribing done appropriately?
Treatment involves defining the problem, specifying the therapeutic objective and choosing the treatment.
Drug choice is based on efficacy, safety, suitability and cost
What must be done before prescribing?
Be familiar with guidelines for quality use of medicine in Australia’s National medicines Policy.
Obtain full medical and medication history prior
Give the patient reasons and clear instructions about treatment.
Write an appropriate and accurate prescription
What should be included in a legal prescription?
Prescriber’s name, address, telephone, and qualifications
Patient’s full name
Drug strength and form
Drug dose, route of administration, frequency and duration of treatment.
Quantity of the drug
Signed and dated
For dental treatment only
What are the considerations to make with antimicrobial prescriptions?
MINDME
Microbiology guides therapy wherever possible
Indications should be evidence-based
Narrowest spectrum required
Dosage appropriate to site and type of infection
Minimize duration of therapy
Ensure monotherapy in most situations
How are antibiotics prescribed for prophylactic use?
A single perioperative dose is sufficient to achieve therapeutic tissue concentrations. Repeat dose is only required in cases where the drug has a short half life and procedure is prolonged.
When should antimicrobials be used prophylactically?
To prevent infection in clinical situations where there is a significant risk of infection.
Use is restricted to situations in which prophylaxis is shown to be effective or consequences of infection are disastrous.
Which cardiac conditions require endocarditis prophylaxis?
Prosthetic cardiac valve / valve repair
Previous infective endocarditis
Cardiac transplantation with valvulopathy
Rheumatic heart disease in indigenous Australians
Congenital heart disease - unrepaired cyanotic defects and residual defects at site of prosthetic patch or device
When are surgical antibiotics used for prophylaxis in dentistry?
Rarely indicated to prevent surgical site infection.
Maxillofacial procedures
In immunocompromised patients
In patients on immunosuppressive therapies
What patients often have immunocompromisation?
End stage renal disease
End stage liver disease
Malignancies
Untreated or end stage HIV infection
Malnutrition
Autoimmune and inflammatory conditions
Organ transplants
Which antibiotics are provided for surgical antibiotic prophylaxis in dentistry?
Phenoxymethylpenicillin 2g (Child: 40mg/kg) orally 1 hour before procedure
Or Amoxicillin 2g (child 40mg/kg) orally 1 hour before procedure
Or if hypersensitive to penicillin: Clindamycin 600mg (child: 15mg/kg) 1 hour before procedure
What is antimicrobial use for empirical therapy?
Causative organism not proven and treatment commences before culture susceptibility results available.
When should antimicrobial be used for empirical therapy?
Use where proven benefits are substantial
Avoid in self-limiting illness
What should empirical therapy be based on?
Base therapy on most likely pathogen and their antimicrobial susceptibility. Use narrowest spectrum antimicrobial.
What should be done before empirical therapy is commenced?
Obtain specimens for culture.
Gram stain results can be used to direct therapy at the start
What should be done with empirical treatment if the diagnosis was confirmed to be non-infective?
Cease therapy immediately
What should be done with empirical therapy if there is no proven causative organism at 48 hours?
Evaluate the clinical and microbiological justification for continuing therapy.
Liase with local path lab for up-to-date information on local antimicrobial resistance patterns.
What is used to guide directed therapy?
Culture susceptibility results used to guide therapy
