Stewardship, FWBD Flashcards
Core elements of AMS program
AMS: antimicrobial stewardship program
1: leadership
2: policies, guidelines, pathways
3: surveillance, AMU, AMR
4: action
5: education
6: performance evaluation
AMU / AMR
AMU: antimicrobial use
AMR: antimicrobial resistance
Restricted antimicrobials
- Cefepime
- Ertapenem
- Meropenem
- Vancomyicn
- Aztreonam
- Colistin
- Linezolid
- Amphotericin B
- Voriconazole
- Micafungin
Monitored antimicrobials
3rd gen cephalosprins
All fluoroquinolones
All aminoglycosides
Clindamycin
Components of AMS’ Action
Action 1: Antimicrobial restriction and pre-authorization
Action 2: Seventh Day Automatic Stop Order
Action 3: Point of Care interventions
Action 4: Audit and Feedback
AMS’ POC interventions
Dose optimization
Streamlining or de-escalatiotn of antimicrobial therapy
IV-to-PO antimicrobial therapy switch
Antibiotics suitable for IV-to-PO switch
(Bioavailability >90%) Azithromycin Clindamycin co-trimoxazole Fluconazole Fluoroquinolones: cipro, levo, moxi Linezolid Metronidazole
Indictions for prolonged IV antimicrobial therapy
Deep-seated infections (e.g. abscess, empyema) S aureus bacteremia Meningitis or encephalitis Septic arthritis Osteomyelitis Endocarditis Necrotizing soft tissue infection Infected implants or prosthesis Febrile neutropenia
Microbiologic factors
Site of infection Severity of infection Bacterial load Infection at sequestered sites Prior antimicrobial therapy Local factors
Host-related factors
Age Genetic factors Hepatic and renal function Pregnancy and nursing status Host defense mechanisms Co-morbid conditions Previous history of adverse drug reactions
Drug related factors
Pharmacodynamics Pharmacokinetics Adverse effeects Drug interactions Cost/benefit ratio
5 infectious FWBD that are under suveillance in the Philippines
Acute bloody diarrhea Cholera Rotavirus Hepatitis A Typhoid
The most common symptom of food and water-borne diseases
Diarrhea
The most threatening consequence of diarrea is
Dehydration
Fluid deficit
INFANT
No signs: <5%
Mild to mod: 5-10%
Sev: >10%
CHILD
No signs: 3%
Mild to mod: 6%
Sev: 9%
