Prudent Use of Antibiotics Flashcards
What are common unnecessary antibiotic prescriptions?
What percentage are unnecessary?
Air infection – 30%
Common cold – 100%
Bronchitis – 80%
Sore throat – 50%
Sinusitis – 50%
What is an empiric diagnosis?
What is necessary to make one?
What kind of antibiotics are used?
What are the drawbacks?
Initiation of treatment prior to determination of a firm diagnosis
Needs to be a legitimate pathogen in mind and history
Broad-spectrum while empiric but switch to focused antibiotic when pathogen determined
Multiple drugs
More expensive
More adverse reactions
What kind of antibiotics are used in directed therapy?
What advantages are present for directed therapy?
How do you determine which antibiotics to use?
Narrow spectrum with one or seldom two drugs
Less adverse reactions
Less expensive
Based on culture and susceptibility results
How is a susceptiblity study interpreted?
What concerns should be considered regarding MIC?
Interpretation of MIC or KB zone as S, I, R
Do not just pick the one with the lowest MIC
What are some adverse drug events related to antibiotics?
Hypersensitivity/allergy
Drug side effects
C. difficile infection
Antibiotic associated diarrhea/colitis
How many ED visits are antibiotic adverse drug effects (ADEs)?
What percentage of ADEs are from antibioitcs?
What percentage are from allergy?
Which two drugs are biggest contributors?
What percent require hospital admission?
142,5050 estimated ED visits
19.3% of all ADEs: 78.7% for allergic
Approximately 50% due to penicillin & cephalosporin classes
6.1% require hospital admission
Why do we need to improve in-patient antibiotic use? (4)
Misuse in hospitals: Doctors being overly cautious based on fear instead of reasoning
Adversely impacts patients and society
Improving antibiotic use improves patient outcomes and saves money
Improving antibiotic use is a public health imperative
What are the types of misuse?
Given when not needed
Continued when they are no longer necessary
Given at wrong dose
Broad spectrum agents are used to treat very susceptible bacteria
Wrong antibiotic given to treat an infection
Which population has the highest rate of antibiotic use for antibiotic-resistant pathogens (viruses, etc.)?
Do doctors think that antibiotic over use contribute to resistance?
Do doctors give them for the cold?
Does patient perception of what the disease is alter diagnosis/treatment?
Pediatrics
At least 97% care about overuse…
…and yet 42% give antibiotics for the cold
Yep, 7% more likely to make a bacterial diagnosis, 21% more likely to prescribe antibiotics
Do parents think antibiotics are ncessary for a fever? How about a cough? Even a cold?
Do parents think antibiotics are necessary typically?
Does it matter if the case turns out to be bacterial or viral?
What is the point of this?
Yes for 58,58,32% (Please don’t actually memorize these values Michelle and Victor)
70% believe they are necessary pre-visit
If the case ended up being anti-bacterial it was 81%, if the case ended up being anti-viral it was 66%.
Parents like antibiotics because they don’t know better.
What is the definition of antibiotic stewardship?
What is the purpose?
Definition: System of informatics, data collection, personnel, and policy/procedures which promote the optimal selection, dosing, and duration of therapy for antimicrobial agents throughout the course of their use
Purpose: Limit inappropriate and excessive antibiotic use
Improve and optimize therapy and clinical outcomes for the individual infected patient
What are the goals of antibiotic stewardship?
Reduce antibiotic consumption and inappropriate use
Reduce C. difficile infection
Improve patient outcomes
Increase adherence/utilizations of treatment guidelines
Reduce adverse drug events
Decrease or limit antibiotic resistance
What factors should you consider in the selection of an antibiotic?
Spectrum of coverage
Patterns of resistance
Evidence or track record for the specified infection
Achievable serum, tissue, or body fluid concentration
Allergy
Toxicity
Formulation (IV vs. PO); if PO assess bioavailability
Adherence/convenience (e.g. 2x/day vs 6x/day)
Cost
What other influences on infection should be considered for antibiotics?
Know the patient – Duration of hospitalization, co-morbidities, prior antibiotic use
Identify the site of infection
Know the environment – What are the patterns of resistance in your institution
What are some hurdles to overcome in antibiotic selection?
Cultures difficult to do to provide microbiologic definition (pneumonia, sinusitis, cellulitis)
Negative cultures
Provider beliefs
