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Antimicrobial therapy (AMT)
Principles for rational prescribing1. Is an antibiotic indicated? | 2. Cultures before administering AB in hospitalised patients or patients with recurrent infections | 3. Choose an appropriate empiric antibiotic | 4. Correct dose and route of administration | 5. Start AB rapidly in severe infections | 6. Practice early and effective source control | 7. Evaluate appropriateness everyday |
When is an antibiotic indicated?Depend on diagnosis? | > Fever | > Leukocytosis | > Raised inflammatory markers | > Specific organ dysfunction |
When is an antibiotic indicated?Antibiotics Indicated:
P= prophylactic treatment
> Prevention of new/recurrent infections
E= empirical treatment
> treat for most likely infective organism (no culture results yet)
D= Definitive treatment
> treat w/ AB as per results of microbial culture and sensitivity (MCS) Leukocytes&Inflammatory Markers:Haematology | White Cell count | 4-11/L | + | Erythrocyte sedimentation rate | 0-22mm/hr (men) | + | | | 0-29mm/hr (women) | Platelets | 140-440/L | - | C-reactive protein | 0-10 | + |
| | Prophylactic treatment:Infective endocarditis (patients with prosthetic heart valves/valvular disease) | > Dental, oral or URT procedures | > GU surgery / GI procedures | Rheumatic fever (reoccurrence) | Meningococcal disease (contacts) | Surgical | TB (high risk individuals / contacts) | HIV (high risk individuals / contacts) |
Empiric antibiotic is indicated:Choose by assessing: | 1. Source of infection: Community acquired Before or less than 48 hours of admission to hospital. Microorganism expected? Wild/non-resistant mo's. 1st line antibiotics. Less side effects. | |
Hospital acquired >48 hours after admission or within 30 days of discharge. Microorganisms expected? Mutated / resistant microorganisms. Second line antibiotics. More side-effects. | |
Recurrent | 2. Site of infection: Peripheral line sepsis=skin/soft tissue. Likely pathogen. Staph. aureus. Coagulase negative staphylococci, strep. spp. |
Osteomyelitis:Bacterial infection of bone due to contaguous spread from soft tissues, haematogenous seeding or direct inoculation. | Common aetiologies – S aureus. – Coagulase--‐negative staphylococc | Occasional – Streptococci. - Enterococci. - Gram--‐negative bacilli. | Other – M tuberculosis. – Fungal infections. |
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Osteomyelitis (cont.)Diagnosis and treatment notes. Empiric Treatments:Most likely pathogen for site of infection | > Gram + cocci: | Skin | > Gram - bacilli: | Urethras | > Gram + and -, anareobes: | Large intestine |
Classification of Bacteria:
Empiric Treatment: drug distribution:Will AB reach site of infection? Definitive Treatment:Microbial culture and sensitivity results done. |
Culture of:
> Urine
> Sputum
> Cerebrovascular fluid
> Nasal secretions
> Wound / throat swab
> Blood | | Microbial Culture:Growing microbe to identify the type of bacteria. |
Microbial Sensitivity:
Identify which antibiotics inhibits the growth of the microorganism Microbial Culture (cont.):routes of administration. Microbial Culture (cont.):Recommended duration of definitive treatment. Case study questions:Rationalise if an antibiotic is indicated? | What pharmacological / non-pharmacological treatment would you recommend? | How would you monitor the efficacy and safety of the treatment once initiated? | What is a possible complication of a sore throat? - Otitis media (spread of infection to the middle ear) Meningitis (spread of infection to the lining of brain and spinal canal) Pneumonia (lung infection) |
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