Principles of Antimicrobial Prescribing - Appropriate empiric antibiotic use
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This document outlines the principles of appropriate antimicrobial prescribing and reassessment. It emphasizes the importance of considering patient and epidemiological factors when initially prescribing antimicrobials based on clinical assessment and diagnostic workup. It also stresses reevaluating the appropriateness of antimicrobial therapy throughout the course of illness by reviewing microbiological data, assessing the spectrum of coverage, checking for adverse effects, and evaluating the route and duration of therapy. The goal is to prescribe the optimal antibiotic based on an informed reevaluation.
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Principles of Antimicrobial Prescribing - Appropriate empiric antibiotic use
- 1. Principles of Antimicrobial Prescribing PART 2
- 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
- 3. Subsequent evaluationInitial evaluation Clinical assessment Diagnostic work-up Patient education Therapeutic decisions Modify antimicrobials Data review Clinical re-assessment antimicrobials must be assessed daily 3
- 4. An informed re-evaluation Review micro- biologic data Assess spectrum Check for adverse effects Evaluate route & duration of therapy Optimal antibiotics Core Competencies 1, 2, 4, 5 4
- 5. An informed re-evaluation Review micro- biologic data Assess spectrum Check for adverse effects Evaluate route & duration of therapy Optimal antibiotics Core Competencies 1, 2, 4, 5 5
- 6. An informed re-evaluation Review micro- biologic data Assess spectrum Check for adverse effects Evaluate route & duration of therapy Optimal antibiotics Core Competencies 1, 2, 4, 5 6
- 7. An informed re-evaluation Review micro- biologic data Assess spectrum Check for adverse effects Evaluate route & duration of therapy Optimal antibiotics Core Competencies 1, 2, 4, 5 7
- 8. An informed re-evaluation Review micro- biologic data Assess spectrum Check for adverse effects Evaluate route & duration of therapy Optimal antibiotics Core Competencies 1, 2, 4, 5 8
- 9. Review micro- biologic data Assess spectrum Check for adverse effects Evaluate route & duration of therapy Positive cultures could mean: • Contamination • Colonization • Infection Does the microbiologic data make sense? 9
- 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
- 12. Unintended consequences? Review micro- biologic data Assess spectrum Check for adverse effects Evaluate route & duration of therapy Re-evaluate dosing based upon renal function 12
- 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
- 18. Urine culture: E.coli WHO/O. Karatuna 18
- 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
- 22. Unintended consequences? Review micro- biologic data Assess spectrum Check for adverse effects Evaluate route & duration of therapy Renal function normal 22
- 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
- 30. 30
- 31. Quiz time! Please click “Next” to proceed.