Principles of therapy

Question 1

what patient factors must be considered when selecting an antibiotic?

Answer 1

1) history of allergy
2) renal and hepatic function
3) susceptibility to infection ( immunocompromised)
4) ability to tolerate drugs by mouth
5) severity of illness
6) risk of complications
7) ethnic origin
8) age
9) whether taking other medication
10) if female, pregnant, BF or taking an COC

Question 2

In patients receiving antibacterial prophylaxis who have been diagnosed with an acute infection. How is an antibiotic selected?

Answer 2

An antibacterial from a different class should be used.

Question 3

The safest antibiotics in pregnancy are :

Answer 3

penicillins and cephalosporins e.g. cefalexin (used in UTI)

Question 4

Which spectrum antibiotics are generally preferred?

Answer 4

narrow-spectrum antibacterials are preferred to broad-spectrum antibacterials unless there is a clear clinical indication (e.g. life-threatening sepsis)

Question 5

how often should intravenous antibacterials be reviewed?

Answer 5

within 48 hours and consider stepping down to oral antibacterials where possible.

Question 6

Outline the management of early sepsis

Answer 6

1) broad-spectrum antibacterial at the max dose without delay (within one hour)
2) Microbiological samples and blood cultures taken prior to administration of antibiotics. Then adjust drugs based on susceptibility
3) clinical examination to identify sources of infection
4) suspected infection, but no confirmed diagnosis, should be treated with an intravenous antibiotic
5) IV fluids, inotropes, vasopressors and oxygen should also be assessed, taking into consideration the patient’s lactate concentration, systolic BP, and risk of severe illness
6) Patients at high risk monitored every 30 minutes.