(02) Appropriate Antibiotic Use Flashcards

1
Q

What are the 2 overall purposes of antibiotic stewardship?

A
  1. Limit inappropriate and excessive antibiotic use

2. Improve and optimize therapy and clinical outcomes for the individual patient

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2
Q

What are the 6 goals of antibiotic stewardship programs?

A
  1. Reduce antibiotic consumption and inappropriate use
  2. Reduce Clostridium Difficile Infections
  3. Improve Patient outcomes
  4. Increase adherence/utilization of treatment guidlines
  5. Reduce adverse Drug events
  6. Decrease or limit antibiotic resistance
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3
Q

What are 8 factors you should consider when choosing an antibiotic regimen?

A
  1. Spectrum of Coverage
  2. Patterns of Resistance
  3. Evidence for Track Record of specified drug
  4. Achievable concentration in serum, body fluid, or tissue
  5. Allergy
  6. Toxicity
  7. Formuation (IV vs. PO)
  8. Adherance to Regimine (2x per day vs. 6x per day)
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4
Q

Empiric Therapy

  • When?
  • What is used?
  • number of drugs used?
  • Diagnosis confidence?
  • Side effects?
  • Cost?
A

When:
- used when the infection is not well defined

What:
- Broad spectrum antibiotics are typically used

Number:
- Often multiple drugs are used

Diagnosis:
- Weak evidence for making diagnosis

Cost:
- More expensive

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5
Q

Directed Therapy

  • When?
  • What is used?
  • number of drugs used?
  • Diagnosis confidence?
  • Side effects?
  • Cost?
A

When:
- Infection is well defined

What:
- Narrow Spectrum Drugs used

Number of Drugs:
- one, seldom 2 drugs

Diagnosis confidence:
- Strong evidence supports the diagnosis

Side Effects:
- Fewer adverse reactions

Cost:
- Less expensive

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6
Q

Which therapy type is used more frequently, empiric of directed?

A

Empiric Therapy is most often used

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7
Q

Why is empiric therapy more commonly used?

A
  • We need to act act quickly
  • Difficult or Negative cultures
  • Fear of missing something
  • Continuing same drugs because they’ve worked in the past
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8
Q

How is directed therapy done?

A
  • Obtain cultures
  • Have the courage to make the diagnosis
  • Don’t rely on response therapy
  • Know situations in which direct therapy is definitely indicated
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9
Q

What are some diseases in which therapy used against them should definitely be directed?

A
  1. Acute Otitis Media (AOM)
  2. Community Acquired Pneumonia (CAP)
  3. Group A Strep. (us Penicillin)
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10
Q

What are the 4 Tenents of appropriate antibiotic use?

A
  1. Treat bacterial infection NOT colonization
  2. Don’t treat sterile inflammation or abnormal imaging without infection
  3. DO NOT treat viruses with antibiotics
  4. Limit duration of antibiotic therapy to an appropriate length.
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11
Q

What are 3 general causes of antibiotic market failure?

A
  1. Scientific
  2. Economic
  3. Regulatory
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12
Q

What is the GAIN act?

- how does it change medicine

A
  • Added exclusivity for antibiotics for priority review

- based on the bugs they kill NOT the infection

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13
Q

What drives the cost of a drug in the U.S.

A

Fear of disease

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14
Q

Why is developing antibiotics not economically viable for drug companies?

A
  • Cost a lot to develop
  • Short Treatment duration
  • 3 limited patient pool (any new antibiotics made will only be used as last resorts to avoid resistance)
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