Suad AL-Sulimani R3
Introduction : <ul><li>in the acute setting of the emergency department (ED), it is often necessary to make treatment deci...
Outline <ul><li>Basic knowledge of Antimicrobial Spectrum of activity . </li></ul><ul><li>Discuss the indications of  freq...
<ul><li>Gram +ve bacteria </li></ul><ul><li>Cocci : </li></ul><ul><li>=Strept: pyogen ,pnumoniae , viridans </li></ul><ul>...
<ul><li>Gram -ve bacteria </li></ul><ul><li>Cocci : </li></ul><ul><li>= Neisseria gonorrhea , Niesseria Meningitidis </li>...
Spectrum of Activity Narrow-Spectrum Antimicrobial Wide-Spectrum Antimicrobial
` St Re pt enterococcus Staph .aeru M R S A H.Influ morexella niesseria Psudomonus  Gram –ve rods e.coli anaerob Penicilli...
` cephalosporins strptococcus enterococcus Staph .aerus MRSA H.influ morexella niesseria Psudomonus  Gram –ve rods  ecoli ...
*/ Common antibiotics  Spectrum of activities Macrolides (bacteriostatic) - Erythromycin (also azithromycin, clarithromyci...
Oral Quinelones <ul><li>Flouroquinolones (cont.). </li></ul><ul><ul><li>Trovafloxacin. </li></ul></ul><ul><ul><ul><ul><li>...
<ul><li>Urinary tract  </li></ul><ul><li>infection  </li></ul>
CYSTITIS & UTI <ul><li>COMMON ORGANISM : </li></ul><ul><li>-   80-85% E.COLI  </li></ul><ul><li>- 5-1-% STAPH SAPROPHYTICU...
<ul><li>Evedience based advances  : </li></ul><ul><li>Most of the b-lactams appear to be less effective  may yield increas...
<ul><li>Antibiotic therapy for three days was similar to prolonged therapy (≥5 days)  in achieving symptomatic cure, while...
<ul><li>Evedience based advances  : </li></ul><ul><li>In randomized double-blind trial, bacteriologic and  clinical succes...
<ul><li>Common organisms:  </li></ul><ul><li>- Enterobacteriaceae, </li></ul><ul><li>-P. aeruginosa, enterococci </li></ul...
<ul><li>Community Acquired </li></ul><ul><li>Pneumonia (CAP ) </li></ul>
Common organisms in CAP <ul><li>No co-morbidity :  Most common organism strept.pnumonae 2/3 of the cases ,Atypicals—M. pne...
<ul><li>Evidence based advances  : </li></ul><ul><li>There is abundant evidence that  macrolide monotherapy  is highly eff...
<ul><li>Presence of comorbidities,  </li></ul><ul><li>- chronic heart, lung,liver, or renal disease </li></ul><ul><li>- di...
<ul><li>Respiratory fluoroquinolones  (levofloxacin, moxifloxacin or gemifloxacin  were more likely to result in treatment...
<ul><li>Bacterial Meningitis </li></ul>
Empiric Therapy—immunocompetent Age: Preterm to <1 mo Group B strep 49%, E. coli 18%, listeria 7%, AMP + cefotaxime  AMP +...
Age > 50 years or alcoholism or other deblitating illneesses , immunocompromized Strpt .Pnumoniae,listeria, gram –ve bacil...
Delay  in initial antibiotics in the emergency department (median delay of four hours)  was associated with a worsening of...
<ul><li>patients with pneumococcal meningitis ,  a delay in antibiotic treatment of more than three hours after hospital a...
Fever  Interval before Diagnosis, Prior Antibiotic Treatment, and Clinical Outcome for Young Children with Bacterial Menin...
<ul><li>Skin and Soft-Tissue Infections inthe Era of Resistance: MRSA and More </li></ul>
<ul><li>CA-MRSA: The New Epidemic </li></ul><ul><li>A global emerging health problem 8-12% of MRSA infections </li></ul><u...
Risk factors to develop CAMRSA soft tissue infection :   =   Antibiotic use (particularly cephalosporin and fluoroquinolon...
Antibiotics & Abscesses <ul><li>- Not required for simple, uncomplicated cases </li></ul><ul><li>- Indications for additio...
Skin and soft tissue infections  Parenteral therapy  •  Vancomycin (30 mg/kg IV every 24 hours in 2 equally divided doses;...
<ul><li>Sepsis </li></ul>
<ul><li>Cutoff  time of <1 hr  for early goal directed therapy  & administration of appropriate antibiotics </li></ul><ul>...
<ul><li>Effectivness of  Antibiotic administration within 1 hr  of hypotension was associated with better survival rate in...
Antibiotics in sepsis  <ul><li>if Pseudomonas is an unlikely pathogen  </li></ul><ul><li>vancomycin with one of the follow...
<ul><li>+ Pseudomonas is a possible pathogen, we combine vancomycin  </li></ul><ul><li>Antipseudomonal cephalosporin (eg, ...
Common antibiotic drug interaction
 
Take home massages  <ul><li>Basic knowledge of antibiotic spectrum of activity is required for infection management </li><...
Take home massages  <ul><li>MRSA soft tissue & wound infection is a newly emerging problem  </li></ul><ul><li>Early Antibi...
THANK YOU
<ul><li>Pregnancy Aerobic Gm-neg. bacilli & </li></ul><ul><li>Staph. hemolyticus </li></ul><ul><li>Screen 1st trimester. I...
Upcoming SlideShare
Loading in …5
×

Antibiotic in ED

4,861 views

Published on

Suad Al Sulimani

0 Comments
4 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
4,861
On SlideShare
0
From Embeds
0
Number of Embeds
9
Actions
Shares
0
Downloads
323
Comments
0
Likes
4
Embeds 0
No embeds

No notes for slide
  • Pain Management on the Battlefield 12/21/10 Kevin C.O&apos;Connor, D.O. Trova Walker RC: The fluoroquinolones. Mayo Clinic Proceedings 1999; 74: 1030-1037. Moxi/Gati -Appelbaum PC: Quinolone activity against anaerobes. Drugs 1999; 58 Suppl 2: 60-64. Hoellman DB, Kelly LM, Jacobs MR, Appelbaum PC: Comparative antianaerobic activity of BMS 284756. Antimicrob Agents Chemother 2001; 45: 589-592. Seciale A, Musumeci R, Blandino G, Milazzo I, Caccamo F, Nicoletti G: Minimal inhibitory concentrations and time-kill determination of moxifloxacin against aerobic and anaerobic isolates. Int J Antimicrob Agents 2002; 19: 11-118. Mather R, Karenchak LM, Romanowski EG, Kowalski RP: Fourth generation flouroquinolones: new weapons in the arsenal of opthalmic antibiotics. Am J Ophthalmol 2002; 133: 463-466. Ackerman G, Schaumann R, Pless B, Claros MC, Goldstein EF, Rodloff: Comparative activity of moxifloacin in vitro against obligately anaerobic bacteria. Eur J Clin Microbiol Inf Dis 2000; 19: 228-232. - Ling ML, Tan PL: In vitro activity of moxifloxacin against local bacterial isolates. Ann Acad Med Singapore 2001; 6: 607-610
  • Antibiotic in ED

    1. 1. Suad AL-Sulimani R3
    2. 2. Introduction : <ul><li>in the acute setting of the emergency department (ED), it is often necessary to make treatment decisions of infection without precise knowledge of infectious source or microbial species </li></ul><ul><li>In certain cases (e.g., suspected meningitis, gram-negative sepsis, bacterial peritonitis, pneumonia), early empiric therapy may be lifesaving. </li></ul><ul><li>Unnecessary use of Antibiotics in ED contribute in emerging new antimicrobial resistance </li></ul>
    3. 3. Outline <ul><li>Basic knowledge of Antimicrobial Spectrum of activity . </li></ul><ul><li>Discuss the indications of frequently used antibiotics in Emergency . </li></ul><ul><li>Antibiotics guideline use in (UTI ,Meningitis , CAP & soft tissue infection ) </li></ul><ul><li>Evidence based Advances in Early ED Antibiotic use . </li></ul><ul><li>Review the most common drug interactions of the most commonly used Antibiotics </li></ul>
    4. 4. <ul><li>Gram +ve bacteria </li></ul><ul><li>Cocci : </li></ul><ul><li>=Strept: pyogen ,pnumoniae , viridans </li></ul><ul><li>=Staph : aureus ,epidermus , saprophyticus </li></ul><ul><li>Bacilli : </li></ul><ul><li>=clostridium </li></ul><ul><li>=Bacillus </li></ul><ul><li>= Listeria </li></ul>
    5. 5. <ul><li>Gram -ve bacteria </li></ul><ul><li>Cocci : </li></ul><ul><li>= Neisseria gonorrhea , Niesseria Meningitidis </li></ul><ul><li>Bacilli : </li></ul><ul><li>=Klebsella , Ecoli , Enterobacter ,Psudomonus aerogenosa </li></ul><ul><li>CoccoBacilli : </li></ul><ul><li>= H.influenzae , B.Pertussis </li></ul>
    6. 6. Spectrum of Activity Narrow-Spectrum Antimicrobial Wide-Spectrum Antimicrobial
    7. 7. ` St Re pt enterococcus Staph .aeru M R S A H.Influ morexella niesseria Psudomonus Gram –ve rods e.coli anaerob Penicillin Amoxacillin/Ampicillin + + 0 0 +/- 0 +(niesseria meningitis 0 0 0 Amoxicillin/calvu(oral + + + 0 + + + 0 + + Tazobactaum /Pipracellin (iv ) + + + 0 + + + + + + Carbapenums (imepenu meropenum + + e.fecalis only + 0 + + + + + +
    8. 8. ` cephalosporins strptococcus enterococcus Staph .aerus MRSA H.influ morexella niesseria Psudomonus Gram –ve rods ecoli 1 st generation Cephalexin + 0 + 0 + not cephalexin +/- 0 0 0 2 nd generation Cefuroxime , cefacolr + 0 + 0 + + cefacolr +/- +/- 0 +/- 3 rd generation Ceftriaxone ,cefexime + 0 + 0 + + + +/- + 3 rd generation (antipsudomonus Ceftazidine + 0 +/- 0 + + +/- + + 4 th generation cefepime + 0 + 0 + + + + +
    9. 9. */ Common antibiotics Spectrum of activities Macrolides (bacteriostatic) - Erythromycin (also azithromycin, clarithromycin) Gram-positive bacteria, Mycoplasma, Legionella Aminoglycosides (bactericidal) Streptomycin, kanamycin, gentamicin, tobramycin, amikacin, netilmicin and neomycin (topical) gram-negative and some gram-positive bacteria. They are not useful for anaerobic bacteria, Tetracyclines (bacteriostatic) Tetracycline, minocycline and doxycycline b. Spectrum of activity - These are broad spectrum antibiotics and are useful against intracellular bacteria Chloramphenicol, lincomycin, clindamycin (bacteriostatic) Chloramphenicol - Broad range Lincomycin and clindamycin - Restricted range Quinolones - nalidixic acid, ciprofloxacin, oxolinic acid (bactericidal) Gram-positive cocci , gram –ve bacteria
    10. 10. Oral Quinelones <ul><li>Flouroquinolones (cont.). </li></ul><ul><ul><li>Trovafloxacin. </li></ul></ul><ul><ul><ul><ul><li>Covers Gm pos, neg, and anaerobes. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Hepatotoxicity with prolonged use. Absorption delayed by morphine. </li></ul></ul></ul></ul><ul><ul><li>Moxifloxacin. </li></ul></ul><ul><ul><ul><ul><li>Covers Gm pos, neg, and anaerobes. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Good vs. Clostridium and Bacteroides – same range as metronidazole, and superior to clindamycin. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>QD dosing. </li></ul></ul></ul></ul><ul><ul><li>Gatifloxicin. </li></ul></ul><ul><ul><ul><ul><li>Covers Gm pos, neg, and anaerobes. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Very similar to moxifloxacin, but less expensive . </li></ul></ul></ul></ul><ul><ul><ul><ul><li>QD dosing. </li></ul></ul></ul></ul>
    11. 11. <ul><li>Urinary tract </li></ul><ul><li>infection </li></ul>
    12. 12. CYSTITIS & UTI <ul><li>COMMON ORGANISM : </li></ul><ul><li>- 80-85% E.COLI </li></ul><ul><li>- 5-1-% STAPH SAPROPHYTICUS </li></ul><ul><li>-KLEBSIELLA & POTEU CAUSE MINORITY OF CASE </li></ul>
    13. 13. <ul><li>Evedience based advances : </li></ul><ul><li>Most of the b-lactams appear to be less effective may yield increased incidences of recurrences and of adverse effects . </li></ul><ul><li>Amoxicillin is thus no longer recommended as empirical therapy for uncomplicated UTI </li></ul>(the sanford guide for antimicrobial therapy 2010) CHARACTER OF PATIENTS SUGGESTED NTIBIOTIC DURATION <ul><li>Uncomplicated acute bacterial cystitis </li></ul>1)Trimethoprim-sulfamethoxazole or trimethoprim .(IA) 2)Fluoroquinolones, ofloxacin (IA) , norfloxacin ,(AII ciprofloxacin, AII and fleroxacin AII nitrofurantoin,) 3)b-lactams (E,I). 3 DAYS 3-7 DAYS
    14. 14. <ul><li>Antibiotic therapy for three days was similar to prolonged therapy (≥5 days) in achieving symptomatic cure, while prolonged treatment was more effective in obtaining bacteriologic cure. </li></ul><ul><li>There is no apparent benefit in extending therapy with TMP-SMX or a fluoroquinolone past three days , and adverse reactions are more common in patients treated with longer regimens. </li></ul>
    15. 15. <ul><li>Evedience based advances : </li></ul><ul><li>In randomized double-blind trial, bacteriologic and clinical success higher for 7 days of CIP than for 14 days of TMP-SMX; failures correlated with TMP-SMX in vitro resistance. </li></ul><ul><li>Since CIP worked with 7-day rx, suspect other FQs effective with 7 days of </li></ul><ul><li>therapy; Levo 750 mg FDA-approved for 5 days </li></ul>(the sanford guide for antimicrobial therapy 2010) CHARACTER OF PATIENTS SUGGESTED NTIBIOTIC DURATION <ul><li>Uncomplicated acute pyelonephritis </li></ul><ul><li>Resistance of E. coli to TMP/SMX 13-45% in collaborative </li></ul><ul><li>ER study (CID 47:1150, 2008). </li></ul>1)oral fluoroquinolone , Levo 750 mg q24, Oflox 400 mg bid, Moxi NAI 400 mg q24h (A,II). 2) CIP 500 mg bid or CIP-ER(AII) 1000 mg q24hpossibly If a gram-positive bacterium is the likely causative organism, amoxicillin or amoxicillin/clavulanic acid may be used alone (B,III) 2 weeks 7 days
    16. 16. <ul><li>Common organisms: </li></ul><ul><li>- Enterobacteriaceae, </li></ul><ul><li>-P. aeruginosa, enterococci </li></ul><ul><li>-rarely S. aureus </li></ul>(CID 42:46,2006) CHARACTER OF PATIENTS SUGGESTED NTIBIOTIC DURATION Complicated UTI/catheters Obstruction, reflux, azotemia, transplant, Foley catheterrelated, R/O obstruction <ul><li>(AMP + gent) or PIP-TZ (Tazocin ) or </li></ul><ul><li>TC-CL ticarcillin-clavulanate or or IMP = imipenem- or MER meropenem </li></ul><ul><li>(IV FQ: CIP, Gati, Levo) or </li></ul><ul><li>Ceftaz or Cef </li></ul>2-3weeks
    17. 17. <ul><li>Community Acquired </li></ul><ul><li>Pneumonia (CAP ) </li></ul>
    18. 18. Common organisms in CAP <ul><li>No co-morbidity : Most common organism strept.pnumonae 2/3 of the cases ,Atypicals—M. pneumoniae, , viral </li></ul><ul><li>Co-morbidity: </li></ul><ul><li>Alcoholism: S. pneumo,anaerobes, coliforms </li></ul><ul><li>COPD: H. influenzae,M. catarrhalis, S. pneumo </li></ul><ul><li>IVDU: Hematogenous S. aureus </li></ul><ul><li>Post-CVA aspiration: Oral flora, incl. S. pneumo </li></ul><ul><li>Post- influenza :S. pneumo. And S. aureus </li></ul>
    19. 19. <ul><li>Evidence based advances : </li></ul><ul><li>There is abundant evidence that macrolide monotherapy is highly effective in the treatment of CAP in outpatients with mild to moderately severe disease </li></ul><ul><li>For patients admitted through the emerg dose should be administered while still in the ED .(Moderate recommendation; level III ) </li></ul>Clinical Infectious Diseases 2000;31:383–421 © 2000 by the Infectious Diseases Society of America. <ul><li>Previously healthy and no risk factors for drug-resistant S. pneumoniae (DRSP) infection </li></ul><ul><li>A macrolide (azithromycin, clarithromycin, or </li></ul><ul><li>erythromycin) (strong recommendation; level I </li></ul><ul><li>evidence) </li></ul><ul><li>Doxycycline (weak recommendation; level III </li></ul><ul><li>evidence) </li></ul>
    20. 20. <ul><li>Presence of comorbidities, </li></ul><ul><li>- chronic heart, lung,liver, or renal disease </li></ul><ul><li>- diabetes mellitus; ---alcoholism; malignancies; </li></ul><ul><li>asplenia; immunosuppressing </li></ul><ul><li>use of immunosuppressing drugs; use of antimicrobials within the previous 3 months (in which case an alternative </li></ul><ul><li>from a different class should be selected) </li></ul><ul><li>A respiratory fluoroquinolone (moxifloxacin, gemifloxacin,or levofloxacin (level I evidence) </li></ul><ul><li>A b-lactam plus a macrolide (strong recommendation (level I evidence) </li></ul><ul><li>alternatives include ceftriaxone, </li></ul><ul><li>cefpodoxime, and cefuroxime [500 mg 2 </li></ul><ul><li>times daily]; doxycycline [level II evidence] </li></ul>
    21. 21. <ul><li>Respiratory fluoroquinolones (levofloxacin, moxifloxacin or gemifloxacin were more likely to result in treatment success than the combination of a beta-lactam plus a macrolide for the treatment of CAP that was mostly mild to moderate in severity (odds ratio, OR 1.39, 95% CI 1.02-1.90) </li></ul>
    22. 22. <ul><li>Bacterial Meningitis </li></ul>
    23. 23. Empiric Therapy—immunocompetent Age: Preterm to <1 mo Group B strep 49%, E. coli 18%, listeria 7%, AMP + cefotaxime AMP + gentamicin Age: 1 mo– 50 yrs S. pneumo, meningococci, H. influenzae now very rare, listeria unlikely if young & immuno-competent (add ampicillin if suspect listeria: 2 gm IV q4h) Adult dosage: [( Cefotaxime 2 gm IV q4–6h OR ceftriaxone 2 gm IV q12h)] + ( dexamethasone) + Vanco [( MER 2 gm IV q8h) (Peds: 40 mg/kg IV q8h)] + IV dexamethasone + vanco
    24. 24. Age > 50 years or alcoholism or other deblitating illneesses , immunocompromized Strpt .Pnumoniae,listeria, gram –ve bacilli 1)AMP 2 gm IV q4h) + (ceftriaxone 2 gm IV q12h or cefotaxime 2 gm IV q6h) + vanco + IV Dexamethasone 2) MER 2 gm IV q8h + vanco + IV dexamethasone. Basilar skull fracture S. pneumoniae , H. influenzae , group A beta-hemolytic streptococci Vancomycin plus a third-generation cephalosporin•Δ Penetrating trauma Staphylococcus aureus , coagulase-negative staphylococci (especially Staphylococcus epidermidis ), aerobic gram-negative bacilli (including Pseudomonas aeruginosa ) Vancomycin plus cefepime; OR vancomycin plus ceftazidime; OR vancomycin plus meropenem
    25. 25. Delay in initial antibiotics in the emergency department (median delay of four hours) was associated with a worsening of hypotension, altered mental status, and seizures in about 15 percent of patients . Those patients whose delay in antibiotic therapy allowed their disease to advance from having zero or one to having two or three poor prognostic indicators had a significant increase in adverse outcomes.
    26. 26. <ul><li>patients with pneumococcal meningitis , a delay in antibiotic treatment of more than three hours after hospital admission was a strong and independent risk factor for mortality (OR 14.1; 95% CI: 3.9 to 50.9). Delayed therapy was a greater risk factor than the isolation of a penicillin-resistant strain (OR 6.83; 95% CI 2.94-20.8) or a higher disease severity (OR 1.12; 95% CI 1.07-1.15) </li></ul>
    27. 27. Fever Interval before Diagnosis, Prior Antibiotic Treatment, and Clinical Outcome for Young Children with Bacterial Meningitis Clinical Infectious Diseases 2001;32:566–572 <ul><li>retrospective chart review, we compared the fever interval that preceded diagnosis with the complication rate among 288 young children (age, 3–36 months ) </li></ul><ul><li>Pneumococcus species were associated with the longest fever interval prior to diagnosis of meningitis, the highest frequency of contact with a clinician before hospitalization, and the highest rate of documented morbidity or mortality . For S. pneumoniae, there was an association between antibiotic treatment received at prior meetings with a clinician and a reduced rate of meningitis‐related complications (odds ratio, 0.14; ). Antibiotic treatment during such meetings is associated with a substantial reduction in disease‐related sequelae. </li></ul>
    28. 28. <ul><li>Skin and Soft-Tissue Infections inthe Era of Resistance: MRSA and More </li></ul>
    29. 29. <ul><li>CA-MRSA: The New Epidemic </li></ul><ul><li>A global emerging health problem 8-12% of MRSA infections </li></ul><ul><li>Most involve skin & soft-tissue structures </li></ul><ul><li>Commonly presents with spontaneous abscess </li></ul><ul><li>Reported in severe infections: </li></ul><ul><li>Bacteremia, Pneumonia (often necrotizing) </li></ul><ul><li>Osteomyelitis Bursitis, arthritis,Meningitis </li></ul>Fridkin SK, et al.N Engl J Med. 2005;352:1436-1444. Pannaraj PS, et al.Clin Infect Dis. 2006;43:953-960.
    30. 30. Risk factors to develop CAMRSA soft tissue infection : = Antibiotic use (particularly cephalosporin and fluoroquinolone use) strongly correlates with the risk for MRSA colonization and infectio = residents of long-term care facilities =Homeless =IV drug users =Prisoners =Military Personnel =HIV patients 60% are abscess, 40% cellulitis , small persentage as impetigo Clin Infect Dis. 2007;45 Suppl 3:S171-6
    31. 31. Antibiotics & Abscesses <ul><li>- Not required for simple, uncomplicated cases </li></ul><ul><li>- Indications for addition of antibiotics: </li></ul><ul><li> Major surrounding cellulitis </li></ul><ul><li> Signs of systemic toxicity </li></ul><ul><li> Facial abscess </li></ul><ul><li> Immunocompromised </li></ul><ul><li> Recurrent abscesses </li></ul><ul><li> Large abscess (≥ 5 cm) </li></ul><ul><li>- Typical duration: 7-10 days </li></ul>The Sanford Guide: 2008, page 47. Lee MC, et al. Pediatr Infect Dis J. 2004;23:123-127. Ruhe JJ, et al.Clin Infect Dis. 2007;44:777-784 .
    32. 32. Skin and soft tissue infections Parenteral therapy • Vancomycin (30 mg/kg IV every 24 hours in 2 equally divided doses; not to exceed 2 g/24 hours unless concentrations in serum are inappropriately low) • Daptomycin (4 mg/kg IV once daily) • Linezolid (600 mg IV twice daily) • Tigecycline (100 mg IV once, thereafter 50 mg IV every 12 hours) Oral therapy • TMP-SMX (2 double-strength tablets orally twice daily) • Doxycycline or minocycline (100 mg orally twice daily) • Clindamycin* (300 to 450 mg orally every 6 to 8 hours) • Linezolid (600 mg orally twice daily)
    33. 33. <ul><li>Sepsis </li></ul>
    34. 34. <ul><li>Cutoff time of <1 hr for early goal directed therapy & administration of appropriate antibiotics </li></ul><ul><li>in severe sepsis & septic shock initiated in emergency department </li></ul><ul><li>are primary determinant of mortality. </li></ul>
    35. 35. <ul><li>Effectivness of Antibiotic administration within 1 hr of hypotension was associated with better survival rate in septic shock </li></ul>
    36. 36. Antibiotics in sepsis <ul><li>if Pseudomonas is an unlikely pathogen </li></ul><ul><li>vancomycin with one of the following: </li></ul><ul><li>Cephalosporin, 3rd or 4th generation (eg, ceftriaxone  or cefotaxime) </li></ul><ul><li>or </li></ul><ul><li>Beta-lactam/beta-lactamase inhibitor (eg, piperacillin-tazobactam, ticarcillin-clavulanate </li></ul><ul><li>or </li></ul><ul><li>Carbapenem (eg, imipenem or meropenem </li></ul>
    37. 37. <ul><li>+ Pseudomonas is a possible pathogen, we combine vancomycin </li></ul><ul><li>Antipseudomonal cephalosporin (eg, ceftazidime, cefepime, or </li></ul><ul><li>Antipseudomonal carbapenem (eg, imipenem, meropenem), or </li></ul><ul><li>Antipseudomonal beta-lactam/beta-lactamase inhibitor (eg, piperacillin-tazobactam,ticarcillin-clavulanate), or </li></ul><ul><li>Fluoroquinolone with good anti-pseudomonal activity (eg, ciprofloxacin), or </li></ul><ul><li>Aminoglycoside (eg, gentamicin, amikacin), or </li></ul><ul><li>Monobactam (eg, aztreonam) </li></ul>
    38. 38. Common antibiotic drug interaction
    39. 40. Take home massages <ul><li>Basic knowledge of antibiotic spectrum of activity is required for infection management </li></ul><ul><li>Advances in UTI treatment support using antibiotics for shorter course </li></ul><ul><li>Oral Flurquinelones are supported by evedience to be effective in treatment of CAP </li></ul><ul><li>Early AB in meningitis is proven to reduce complications & improve outcome </li></ul>
    40. 41. Take home massages <ul><li>MRSA soft tissue & wound infection is a newly emerging problem </li></ul><ul><li>Early Antibiotics in sepsis is part of early goal directed therapy </li></ul>
    41. 42. THANK YOU
    42. 43. <ul><li>Pregnancy Aerobic Gm-neg. bacilli & </li></ul><ul><li>Staph. hemolyticus </li></ul><ul><li>Screen 1st trimester. If positive, rx 3–7 days with amox, </li></ul><ul><li>nitrofurantoin, O Ceph, TMP-SMX, or TMP alone </li></ul><ul><li>Screen monthly for recurrence. Some authorities treat continuously until delivery </li></ul><ul><li>(stop TMP-SMX 2 wks before EDC). ↑ resistance of E. coli to TMP-SMX. </li></ul><ul><li>Before and after invasive urologic </li></ul><ul><li>intervention, e.g., Foley </li></ul><ul><li>catheter </li></ul><ul><li>Aerobic Gm- </li></ul>

    ×