rational atb use

Question 1

antimicrobial agent

Answer 1

chemical compound that kills or inhibits the growth of a microorganism

Question 2

antibiotic

Answer 2

only natural compound of microbial origin

Question 3

antimicrobial resistance

Answer 3

bacterial ability to survive antimicrobial treatment
quantitative property

Question 4

rational antimicrobial use

Answer 4

suggests a responsible attitude to antimicrobial use, optimising clinical efficacy while minimising development of resistance

Question 5

MRSA/MRSP

Answer 5

Methylin resistant staphylococcus aureus/pseudointermedius
contain mecA gene conferring resistance to all beta lactams (penicillins and cephalosporins) detection using oxacillin/cefoxitiem discs

Question 6

ESBL

Answer 6

extended spectrum beta lactamase inhibitors
enzyme able to hydrolyse/inactivate most beta lactams (except carbapenemes), these strains are often resistant to other drug classes

Question 7

MDR

Answer 7

multi drug resistant
resistance to 3 or more antimicrobial classes

Question 8

CIA

Answer 8

critically important antimicrobials
reserved for use in humans

Question 9

how does resistance occur

Answer 9

antibiotics kill most of the bacteria
some resistant ones survive
the resistant bacteria multiply and pass on their resistant gene
the new population are the more resistant to the drug
occurs in whole body (Gut) not just at treated site

Question 10

causes of atb resistance

Answer 10

over prescribing
wrong dose/kind/duration
over use in farm animals
poor infection control in hospitals and clinics

Question 11

antimicrobial stewardship

Answer 11

minimise development through
- rational use of antimicrobials
- infection control practices (biosafety) means less need
- education and surveillance

Question 12

ways of classifying antimicrobials

Answer 12

chemical structure
origin
application
type or action
mechanisms
spectrum
efficacy dependent on

Question 13

chemical structure of atb

Answer 13

b-lactams
aminoglycosides
macrolides
quinolones
fluroquinolones

Question 14

origin fo atb

Answer 14

natural
synthetic
semi sythetci

Question 15

mechanism of action atb

Answer 15

cell wall synthesis inhibitors
inhibitors of membrane function
inhibitors of protein synthesis
inhibitors of nucleic acid synthesis

Question 16

type of action atb

Answer 16

bacteriostatic - tetracyclines, sulphonamides, macrolides
bacteriocidal - aminoglycosides, cephalosporins, penicillins, quinolones
often dose dependant - aminoglycosides, fluroquinones, metronidazole

Question 17

efficacy dependent on

Answer 17

dose - quinolones, aminoglycosides
Time - penicillins, cephalosporins
dose and time - clindamycin

Question 18

criteria for empirical antimicrobial choice

Answer 18

ants susceptibility of suspected pathogen
drug penetration and efficacy at infection site
route of admin
frequency of admin toxicity
cost

Question 19

bacteriology testing and AST indicated in case of

Answer 19

complicated or serious infections
lack of response/inadequate response to therapy
recurrent infections
immunocompromised patients
suspicion of MDR bacteria
always preferable in skin and UTI when systemic treatment is planned

Question 20

treating pyoderma

Answer 20

generalized pyoderma - always secondary
for localised and superficial infections - topical therapy
topical antiseptics - chlorhexidine
systemic therapy only if really deep/topical not working (check owner compliance)
first choice = clindamycin - mostly staphylococci infections
cytology v useful

Question 21

treating otitis externa

Answer 21

almost always secondary - treat underlying cause
cytology first - so so important
most common = Malassezia pachydermatitis and bacteria (cocci, rods)
if Malassezia then no atb just antifungals
if cocci - often staph - topical therapy
if rods - bacteriology needed. gram neg rods eg Pseudomonas and proteus may need systemic therapy in which AST needed

Question 22

treating urinary infections

Answer 22

always check sediment and do bacterial culture
bacteria in urine has to be quantified
atb based on AST and/or guidelines
some drugs concentrate in urine so even drugs that are intermediately sensitive on AST can be used (aminopenicillines) - they reach higher concs in urine than in serum

Question 23

treating the oral cavity

Answer 23

systemic treatment if fever, lymphadenopathy, swelling or leukocytosis
clindamycin often first choice - ideally based on AST
for gingivitis or parodontitis - systemic therapy not indicated
often topical with chlorhexidien and removal of predisposing condition (tartar) needed

Question 24

treating acute gastroenteritis

Answer 24

often just supportive therapy (often self limiting)
if general condition of animal unchanged, no atb
diagnosis related to bacteria important fo public health esp if immunocompromised or children in house
quantification important as GI pathogens can be found in gut of healthy animals

Question 25

isolating Campylobacter

Answer 25

CCDA podloga
microaerophilic conditions
42 degrees
species identification important

Question 26

isolating salmonella

Answer 26

several culture mediums
aerobic conditions
37 degrees

Question 27

isolation of E.coli

Answer 27

aerobic
37 degrees
typisation
isolation of E.coli from faeces is irrelevant

Question 28

isolation of clostridia

Answer 28

anaerobes
37 degrees
detection of toxins more important

Question 29

treating resp infections

Answer 29

infection of upper resp tract often viral
suboptimal sampling conditions for bacteriology and therefore misguided therapy
If obligatory resp pathogen isolated from nasal/throat swab, it should be considered relevant
if lower airways unaffected and no fever - no atb
consult national or international guidelines

Question 30

diagnosing tick borne diseases

Answer 30

snap test - for antibody detection
interpreted in relation to presenting signs - seropositivity is not necessarily related to manifesting disease, especially in endemic areas
if clinical signs are due to infection - first choice is doxycycline

Question 31

treating sepsis

Answer 31

only clinical condition where immediate antimicrobial therapy, with as wide a spectrum as possible is indicated
hemoculture maybe but often not enough time to isolate causative bacteria and AST before death

Question 32

treating MDR infections

Answer 32

whenever possible try local therapy
MRSA/MRSP often in skin and ear susceptible to fucidic acid
ESBL producing enterobacteria in urine - nitrofurantoin