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Flashcards in 243 Antimicrobial Stewardship Deck (40):
0

How can we determine the severity of a chest infection?

Use curb 65 score
Tells you whether the person can be treated at home, needs hospital supervised treatment, or needs to be managed in hospital

1

Where are anaerobes usually found?

In the mouth, teeth, sinuses, lower bowel
Cause abscesses, dental infections, peritonitis, appendicitis

2

What are the 6 steps to go through with the antibiotic prescribing decision process?

1) diagnosis, rate the severity
2) pick an agent (informed by empirical guidelines, or Mc&S
3) route of admin- IV or oral? Depends on severity
4) dose- based on patient factors
5) duration and review date- IV-oral switch?
6) monitoring- how can we tell if the patients getting better?

3

What are some advantages of MC&S guided therapy?

We can find out what's causing infection
So we know what to treat it with
Treatment should be more successful
Narrow spectrum antibiotics- less s/es, less risk of nosocomial infections
Can use targetted antibiotic therapy

4

What two antibiotics are nephrotoxic?

Gentamicin
Vancomycin

5

What class of antibiotics are contraindicated in epilepsy?

Quinolones
Eg. Ciprofloxacin
These lower seizure threshold
Also interact with phenytoin

6

What two antibiotics should not be used in hepatic impairment?

Rifamicins
Fucidin

7

Which type of allergic reaction involves IgE antibodies?

Type I " allergic immediate"
Anaphylaxis, onset in one hour

8

Which type of allergic reaction involves IgG and IgM antibodies?

Type III
Takes over 72 hours to onset
Immune complexes involved
serious reaction
Purporea rash

9

Warning! Any patient with a history of ___ mediated allergic reactions should not receive a penicillin!! 

IgE mediated

Penicillin ABs include: amoxicillin, ampicillin, flucloxacillin, augmentin, piptazo etc

10

Are other/ idiopathic allergies considered "true allergies?"

No.
Occurs in 1-4% patients receiving penicillins and cephalosporins

11

What is C diff caused by?

Overgrowth of anaerobic bacteria in the gut
Opportunistic
Associated with previous antibiotic administration/ over use of antibiotics with a broad spectrum

12

What do macrolides interact with, and why?

Warfarin
Statins (cause muscle wastage)

This is because they're CYP3A4 inhibitors therefore they increase the levels of these drugs

13

What does RIFAMPCIN interact with, why?

Warfarin
Theophylline
Progesterones-COC, POP

It's a potent inducer of CYP450 enzymes
Increased metabolism of drugs metabolised by these enzymes

14

When should IV (parenteral) antibiotics be reviewed?

After 48 hours of initiation

Review to see if we can change to a narrower spectrum AB as microbiology have come back to us
Or review to switching to ORAL
But certain conditions must be met before switching to oral antibiotics

15

What patients conditions should be met before switching to oral antibiotics?

Temperature below 37.5 for 24 hours
Conditions improving or stabilising
Signs and symptoms improving
Decreasing ESR/ CRP/ WBC
No potential absorption problems with oral
Is there a suitable oral formulation available
Shouldn't be suffering from a high risk infection

16

Who is involved with SURVEILLANCE of antibiotic usage over Europe?

European centre for disease prevention and control (ECDC) (EARS-net: European antibiotic resistance surveillance)
Monitors antibiotic usage and incidence of resistance/ HCAI's

17

Is pyelonephritis considered a high risk infection? Can the IV-oral switch be done?

No
Yes it can be switched

18

What is the oral bioavailability of ciprofloxacin?

100%
Therefore it's fine to switch to oral

19

Is osteomyelitis considered high risk? Can an IV- oral switch be done? Why?

Yes
IV oral switch can't be done
Don't get enough penetration into bone orally

20

Is meningitis considered high risk? What about endocarditis?

Yes both

Don't switch to oral

21

Is gangrene considered high risk?

Yes

22

Is community aq and hospital aq pneumonia considered high risk?

No
IV to oral switch can be done

23

Is severe cellulitis considerd high risk?

Yes
Don't consider switching unless really have to

24

What is mediastinitis?

An infection/ inflammation of tissues in the chest
It is considered high risk

25

When do we monitor peak levels and when do we monitor trough levels in Gentamicin dosing regimens?

O.d or B.d dosing= monitor trough levels only
For t.d.s dosing (with MRSA or endocarditis) monitor both peak and trough levels

26

What is the desired range of trough levels for gentamicin?

Less than 1 mg/ L

27

What's the main bacteria causing UTIs?

E.Coli

28

What's the main bacteria causing CAP?

Streptococcus pneumonia

29

What are the 2 main types of bacteria causing Cellulits?

Streptococcus (B-heamolytic streptococci)
Staphylococcus

30

HAP is usually caused by gram ______ bacilli

Negative

Common causes:
Enterobacteriacea
Pseudomonas
Acineto bacter
Staph aureus
Legionella

31

Renal impairment and gentamicin: what's the deal?

Can still use it in renal impairment BUT consider Piptazo (piperacillin with tazobactam)
If severe renal impairment use Piptazo

Remember gentamicin needs therapeutic drug monitoring

32

What's the formula for ideal body weight and when in antibiotics is it used?

Men: 50 kg + 2.3kg per inch over 5 feet
Women: 45.5kg + 2.3kg per inch over 5 feet

Used to work out corrected weight which is used for obese patients when working out their gentamicin dose!

33

What's the formula for corrected body weight then, used for working out dosing of gentamicin in patients that are obese?

Corrected weight = Ideal body weight + [0.4 X (actual body weight - ideal body weight]

34

If a patient is over 70, what should be the starting dose of gentamicin? What is it usually?

4 mg/kg once daily

Usually it's 5 mg/ kg

35

Gentamicin doses should be rounded DOWN to the nearest multiple of ___mg

40 mg

This is because ampoules come as 40mg!- easier dosing

36

The starting dose of vancomycin in patients with normal renal function is based on what?

Age

Less than 60= 1 mg b.d
60-75= 750 mg b.d
Over 75 = 509 mg b.d

37

When should the initial pre dose level ( first blood sample for drug levels) be taken for Vancomycin?

Initial pre dose should be taken before 3rd or 4th dose
Level should be taken 11-12 hours after previous dose for b.d dosing, within one hour before next one is due

38

When taking blood samples for drug levels, how much should be sent?

Send 3.5ml blood in a yellow top (SST) tube

Write time sample taken
Write words PRE dose

39

When looking at the antibiotic guidelines, do we usually have neutropenic or non neutropenic sepsis?

Non neutropenic
Neutropenic is just for cancer patients with low neutrophils

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