Rational Antimicrobial Use Flashcards
T or F
Antimicrobial use promotes selection of resistant bacteria, thereby reducing their therapeutic efficacy over time
TRUE
What is rational antimicrobial use
Use of antimicrobial agents aimed at maximizing therapeutic efficacy while minimzing risks associated with development of resistance in the strain causing infection as well as in the paients commensal flora
What are the general principles of rational antimicrobial use (4)
Reducing antimicrobial consumption
Improving use of diagnostic testing
Prudent use of 2nd line, critically important antimicrobial
Optimizing dosage regimens
How do you reduce overall AC (3)
By curing the underlying cause of infection since most bacterial infection are secondary to predispensing factor and will occur again unless the factors are identified and removed
Avoiding unnnecesary therapy
Avoiding unnecesary routine prophylaxis
How can the use of diagnostic testing be improved (3)
Maximize use of cytology to guide antimicrobial choice for relevant diseases conditions
Increase the use of culture and suceptibility testing
Use of a good diagnostic laboratory that provides certain services
What good laboratory diagnostics can improve testing (4)
Guidance for optimal specimen management
State of the art methods for identification (MALDI-TOFF MS) and suceptibility testing (MIC determinatiion)
Implementation of transparent and ongoing quiality assurance measure, preferly by accreditated labs
Availability of skilled microbioplogists for case- based expert advice and data interpretation
When is bacteria culture reccomended
No response to therapy Previous antibiotic treatment History of relapse or re-infection Immunocompromised pratients Life threatening infections Patients at riskof MDR carriage or infection High prevalence of AMR Long treatment course (Pyoderma)
use of 2ry line CIAs
minimizing empiric use of CIAs, specially those that have broad spectrum are knwon to select MDR bacterua of clinical interest and should be preserved for treatment of difficult infections
3rd and 4th generation cephalosporins
Cefovecin Cefpodoxime (small animals US only)
Fluoroquinolones
Enroflaxin
Marbflaxin
Pradoflaxin, etc
Macrolides
Older generations (enrythromicin, spiramicin, tylosin, tilmicosin)
Treatment of MRSP and ESBL infections in small animals
Whenever possible, topical treatment for MRSP
Systemic therapy is necessary guided by susceptibility data and unusual drugs may be needed to damage infection
How do you optimize dosage regimens (3)
Use the highest dose
Administer the drug at regular intervals
Treat the earliest and for the shortest time possible
What is antimicrobial stewardship
Refers to coordinated interventions designed to improve and measure the appropiate use of antimicrobial by promoting the selection of optimal antimicrobial drug regimen, duration of therapy, and route of administration
