Prophylaxis- Empirical (antibiogram based) - Culture base

2. Antibiotics Optimisation
 Approximately 80% of hospitalized patients receive an antibiotic
and in an Estimated one-half of cases antibiotic use is
inappropriate. The latter is the result of administration of an
antibiotic when none is indicated, the use of the wrong antibiotic,
incorrect dosing, or an incorrect duration of administration,
 Create Acquired Resistance not Intrinsic RESISTANCE

3. Anti-Bacterial
(Antibiotic)
Anti-fungalAnti-viral

4. Common Pathogen coveredExamplesClass
G +ve
(ampicillins- 1st 2nd generation)
G+ve, -ve
(3rd, 4th cephalosporin)
Broad with anaerobic action
(Crpabenems, pipracillin
tazobactam)
Ampicillins
Cephalosporin
Carbapenems
B-lactam
Gram-negative
(ANTI-PSEUDOMONAL)
Amikacin
Gentamicin
Amino-glycosides
Cipro: mainly G –ve
levo and Moxi: mainly Gm +ve
all cover atypical
Levofloxacin
Ciprofloxacin
Moxifloxacin
Quinolones
Gm +ve mainly
Atypical coverage
Azithromicin
Clarithomicin
Macrolides
Gm +ve mainly
MRSA mainly
Vancomycin
Teichoplanin
Glycopeptides
Gm +ve mainly
VRE, VRSALinezolidesOxazolidinone

5. Microbiological
Culture Based:
- De-escalate or Escalate Empiric
Regimen
- Consider in VIVO/VITRO action
Prophylaxis:
Clean/Contaminated/Di
rty procedures require
24-48 hors
perioperative
(pre/during/post
operative)
Empiric:
- Positive signs of
infection and/or
sepsis marker high
-Unknown Organism

6.  Pre-operative Prophylaxis Single DOSE mostly in all
surgery
 Post-Operative prophylaxis in certain types of
Surgery NOT all and duration for 48 hours
ONLY (like: Cardio-thoracic).
Attached Manual
 ONLY EVIDENCE BASED DOCUMENTED
ANTIBIOTIC PROPHYLAXIS USE
Type of
Surgery
Re-Dosing &
Duration of
Surgery
Type of
Antibiotics,
dose
& Alternative

9. Suspected Site of
Infection
Most common Pathogen
Best Coverage for
Pathogen
International
Guidelines

11.  Certain combinations in sensitivity accepted and others
not
( Beta lactam + Quinolons or Aminoglycosides or
Colisthimate sodium ) √
( Macrolides + Quinolons ) ×
**high risk of QT PROLONGATION without additive benefits
 Resistance in culture and synergism in recent studies
(RCTs)
 Intermediate susceptibility doses
 De-escalate or escalate antibiotic (narrower to broader
or vise versa)
 In VIVO/ VITRO sensitivity and MIC in critical ill or
severely infected patients taken into consideration

12. • Certain Specimen
• Certain location
Local Policy
Antibiogram
• Suspected site of
infection
• Availability
• Recent Updated
International
Guidelines
(at least two
reference)

14.  Use IV if:
 Change after 2-3 days if:
 NOT suitable for:
 Alternative medications and doses Attached
Critical
ill
Febrile or
Hypothermic
Unable to
take Oral
In:
Pneumonia
SSTI
UTI
Simple Intra-abdominal infection

16. • An antimicrobial prescribing policy and
management (Restricted Antibiotic / privilege
LIST )
• A strategy for policy implementation
(Antimicrobial stewardship)
• Antimicrobial formulary and guidelines
• Prescribing should have proper clinical
justification
• IV-oral switch policy
• Reduce broad-spectrum use
• Use single doses for prophylaxis

17. Renal
Elimination
Nephrotoxic
or
Accumulation
(eGFR&IHD&CRRT)
Hepatic
Elimination
Metabolism
or
Hepatotoxic
(Child Pugh level)

18. - Prescribe proper
antibiotic (SSOI-
EBM GUIDELINES)
- Detect duration
“5-7 days” single
dose prophylaxis
- Follow up relevant
lab. Results
KFT,LFT.
- Antibiotic
sensitivity test
- Aware of
antibiotics
- Aware of duration
to aid doctors
- Lab results
documentation
- Dispense with
restricted antibiotic
form
- Aware of
combination avoided
- Aware of specific
coverage and proper
use of prophylactic
and empiric
categories

19. Pre-Operative Prophylaxis Guidelines
(Type of Surgery & Antibiotic use/ re-
dosing according to duration & antibiotic
half life)
International Guidelines (Suspected site of
infection)
 Antimicrobial ICU stewardship
Antibiotic guidelines of IV to Oral Switch
 Antibiotics renal adjustment