Antibacterials, principles of therapy

Question 1

3 factors that need to be considered before selecting an antibacterial

Answer 1

• patient
• bacteria involved
• resistance

Question 2

factors related to the pt which must be considered when prescribing abx

Answer 2

• allergy
• age
• RI/HI
• susceptibility to infection
• route
• severity of illness
• other medications
• females: P, BF, taking OC
• ethnicity
• risk of complications

Question 3

who is at higher risk of treatment failure

Answer 3

• repeated abx courses
• previous or current culture with resistant bacteria
• high er risk of developing complications

Question 4

which spectrum of abx are generally preferred

Answer 4

• narrow spectrum unless there is a clear clinical indication for broad spectrum e.g. life-threatening sepsis

Question 5

which type of injections to avoid in children and why

Answer 5

where possible, avoid IM injections in children as they are painful

Question 6

which abx class is NTI
name some of these abx

Answer 6

aminoglycosides: gentamicin, amikacin, tobramycin, neomycin, and streptomycin

Question 7

reviewing IV abx

Answer 7

review IV abx within 48h and consider stepping down to oral abx where possible

Question 8

what is a superinfection

Answer 8

a second infection superimposed on an earlier one, especially by a different microbial agent of exogenous or endogenous origin, that is resistant to the treatment being used against the first infection

Question 9

which abx are more likely to be associated with superinfection

Answer 9

broad-spectrum abx drugs such as the cephalosporins are more likely to be associated with adverse reactions related to the selection of resistant organisms e.g. fungal infections or antibiotic-associated colitis (pseudomembranous colitis)

Question 10

state two problems associated with superinfection

Answer 10

• vaginitis (inflammation of the vagina that can result in discharge, itching and pain)
• pruritus ani (anal itching)

Question 11

what is meant by notifiable diseases and what does this mean for medical practitioners

Answer 11

• any disease that is required by law to be reported by medical practitioners to the proper officer at their local council or local protection team
• tell them about any pt suspected or suffering from notifiable diseases
• notification form needs to be completed immediately

Question 12

early management of sepsis in a pt high risk of severe illness or death due to suspected sepsis

Answer 12

• broad spectrum abx at max recommended dose without delay, ideally within 1 hour
• take microbiological samples and blood cultures before giving abx
• rx should b adjusted according o susceptibility results
• identify sources of infection and treat in line with local abx guidance or susceptibility results