antibiotics

1. Pharmacology Of Antimicrobials
for Clinicians: Select Topics

2. Course content
Course
roadmap
Basic concepts
Common infections
2

3. “Antimicrobial resistance threatens the
achievement of the Sustainable
Development Goals and requires a
global response…... No one country,
sector or organization can address
this issue alone.”
H.E. Peter Thomson
President of the 71st
session of the UN
General Assembly
September 2016
3

4. Core competencies for
antimicrobial prescribing
C1: Understands the patient and the patient’s clinical needs
C2: Understands treatment options and how they support the
patient’s clinical needs
C3: Works in partnership with the patient and other healthcare
professionals to develop and implement a treatment plan
C4: Communicates the treatment plan and its rationale clearly to
the patient and other health professionals
C5: Monitors and reviews the patient’s response to treatment
4
Core Competencies

5. Objectives
• Introduce basic concepts of
pharmacokinetics/pharmacodynamics of antimicrobials
• Describe oral bioavailability of antimicrobials
• Illustrate the concept of time-dependent antimicrobials and
describe optimizing the use of beta-lactam antibiotics using
prolonged infusion.
5

6. Drug properties
Pharmacokinetics (PK)
Pharmacodynamics (PD)
6

7. Drug properties
Pharmacokinetics (PK)
• What the body does to the drug
Pharmacodynamics (PD)
7

8. Drug properties
Pharmacokinetics (PK)
• What the body does to the drug
Pharmacodynamics (PD)
• What the drug does to the body and microorganism
8

9. PK/PD impacts optimal choice
Drug
Dose
Duration
Route
prescription
.............
.............
.............
9

10. BIOAVAILABILITY & ORAL
ANTIMICROBIALS
Key concept #1:
Core Competencies 1, 2, 3 & 5
10

11. Bioavailability
Achieve serum concentrations comparable
to antibiotics administered intravenously
11

12. Intravenous to oral switch
Optimal antibiotics
Stable? Eating?
Able to
absorb?
Oral
option?
Core Competencies 1, 2, 3 & 5
12

13. Intravenous to oral switch
Stable? Eating?
Able to
absorb?
Oral
option?
Core Competencies 1, 2, 3 & 5
13

14. Intravenous to oral switch
Stable? Eating?
Able to
absorb?
Oral
option?
Core Competencies 1, 2, 3 & 5
14

15. Intravenous to oral switch
Stable? Eating?
Able to
absorb?
Oral
option?
Core Competencies 1, 2, 3 & 5
15

16. Intravenous to oral switch
Stable? Eating?
Able to
absorb?
Oral
option?
Core Competencies 1, 2, 3 & 5
16

17. Bioavailable oral antibiotics
• Fluoroquinolones
• Doxycycline
• Trimethoprim-sulfamethoxazole
• Metronidazole
• Linezolid
• Fluconazole
• Beta-lactams
17

18. 38 year-old female with:
2 day history of fever
left flank pain
dysuria
hypotension
tachycardia
bilateral costovertebral angle tenderness
18

19. Return to case
Severity Source
Drug
resistance
Patient
factors
Cultures
Local guidelines
Intravenous 3rd generation
cephalosporin
19
Core Competencies 1 & 2

20. Subsequent evaluation
Initial evaluation
Clinical
assessment
Diagnostic
work-up
Patient
education
Therapeutic
decisions
Modify
antimicrobials
Data
review
Clinical
re-assessment
20

21. Urine culture: E.coli
WHO/O. Karatuna
21

22. Intravenous to oral switch
Optimal antibiotics
Stable? Eating?
Able to
absorb?
Oral
option?
Core Competencies 1, 2, 3 & 5
22

23. Intravenous to oral switch
Stable? Eating?
Able to
absorb?
Oral
option?
YES
Core Competencies 1, 2, 3 & 5
23

24. Intravenous to oral switch
Stable? Eating?
Able to
absorb?
Oral
option?
YES
Core Competencies 1, 2, 3 & 5
24

25. Intravenous to oral switch
Stable? Eating?
Able to
absorb?
Oral
option?
YES
Core Competencies 1, 2, 3 & 5
25

26. Intravenous to oral switch
Stable? Eating?
Able to
absorb?
Oral
option?
YES
Core Competencies 1, 2, 3 & 5
26

27. Oral options
Recommended agents for treating uncomplicated
pyelonephritis
Drug Recommended duration
Fluoroquinolones 7 days
Trimethoprim-sulfamethoxazole 7 – 14 days
Oral beta-lactams 10 – 14 days
27

28. Fluoroquinolones
• Broad spectrum
antimicrobials
• Commonly misused
• Associated with toxicity
28

29. Fluoroquinolones
• Reserve use for when
other options are not
available.
29

30. Intravenous to oral switch
Oral agent
Stable? Eating?
Able to
absorb?
Oral
option?
Core Competencies 1, 2, 3 & 5
30

31. Review: Pharmacology for Clinicians
Drug
Dose
Duration
Route
prescription
.............
.............
.............
31

32. Please continue to
Part 2 of this
module
WHO/A. Kristensen
32