2. Objectives
• Define the principles of appropriate empiric antimicrobial use
• Consider patient and epidemiologic factors when prescribing
antimicrobials
• Utilize clinical and laboratory data to reassess the
appropriateness of antimicrobial therapy throughout the
course of the patient’s illness
2
10. Verify the spectrum of therapy
Review
micro-
biologic
data
Assess
spectrum
Check for
adverse
effects
Evaluate
route &
duration of
therapy
Review with microbiologic data &
patient’s clinical course
10
11. Verify the spectrum of therapy
Review
micro-
biologic
data
Assess
spectrum
Check for
adverse
effects
Evaluate
route &
duration of
therapy
• De-escalation
• Escalation
• Discontinuation
11
13. How long and by which route?
Review
micro-
biologic
data
Assess
spectrum
Check for
adverse
effects
Evaluate
route &
duration of
therapy
Use evidence-based
guidelines
13
14. How long and by which route?
Review
micro-
biologic
data
Assess
spectrum
Check for
adverse
effects
Evaluate
route &
duration of
therapy
Excessive durations
• Adverse events
• Antibiotic resistance
14
15. How long and by which route?
Review
micro-
biologic
data
Assess
spectrum
Check for
adverse
effects
Evaluate
route &
duration of
therapy
Document
15
16. Return to the case
Review
micro-
biologic
data
Assess
spectrum
Check for
adverse
effects
Evaluate
route &
duration of
therapy
Optimal antibiotics
Core Competencies 1, 2, 4, 5
16
19. Does the microbiologic data make sense?
Review
micro-
biologic
data
Assess
spectrum
Check for
adverse
effects
Evaluate
route &
duration of
therapy
Urine cultures grew E. coli
19
20. Verify the spectrum of therapy
Review
micro-
biologic
data
Assess
spectrum
Check for
adverse
effects
Evaluate
route &
duration of
therapy
The isolate was susceptible to all antibiotics
20
21. Verify the spectrum of therapy
Review
micro-
biologic
data
Assess
spectrum
Check for
adverse
effects
Evaluate
route &
duration of
therapy
Intravenous versus oral?
21
23. How long and by which route?
Review
micro-
biologic
data
Assess
spectrum
Check for
adverse
effects
Evaluate
route &
duration of
therapy
Plan for 10 day course
23
24. Review: Principles of Antibiotic Prescribing
Drug
Dose
Duration
Route
prescription
.............
.............
.............
24
25. Microbiology guides therapy wherever possible
Indications should be evidence based
Narrowest spectrum required
Dosage appropriate to the site and type of infection
Minimise duration of therapy
Ensure monotherapy in most cases
Review: Principles of Antibiotic Prescribing
25
26. Microbiology guides therapy wherever possible
Indications should be evidence based
Narrowest spectrum required
Dosage appropriate to the site and type of infection
Minimise duration of therapy
Ensure monotherapy in most cases
Review: Principles of Antibiotic Prescribing
26
27. Microbiology guides therapy wherever possible
Indications should be evidence based
Narrowest spectrum required
Dosage appropriate to the site and type of infection
Minimise duration of therapy
Ensure monotherapy in most cases
Review: Principles of Antibiotic Prescribing
27
28. Microbiology guides therapy wherever possible
Indications should be evidence based
Narrowest spectrum required
Dosage appropriate to the site and type of
infection
Minimise duration of therapy
Ensure monotherapy in most cases
Review: Principles of Antibiotic Prescribing
28
29. Microbiology guides therapy wherever possible
Indications should be evidence based
Narrowest spectrum required
Dosage appropriate to the site and type of infection
Minimise duration of therapy
Ensure monotherapy in most cases
Review: Principles of Antibiotic Prescribing
29
