Antibiotic Therapy

Question 1

Types of antibiotic therapy

• ________ therapy
  -__________ therapy
• __________ therapy

Answer 1

empiric

definitive

prophylactic

Question 2

Types of antibiotic therapy

-empiric therapy: to provide initial treatment when _____________________________

Answer 2

the identity of causative organisms isn’t known

Question 3

Types of antibiotic therapy

-definitive therapy: treatment of any infection in which ____________________________________

Answer 3

the Aetiologic pathogen and its antibiotic susceptibility is known

Question 4

Types of antibiotic therapy

-prophylactic therapy: to ___________ (______ type and _____ type)

Answer 4

prevent infection

medical

surgical

Question 5

GOOD CLINICAL EVIDENCE OF INFECTION

*systemic inflammatory response

-heart rate is ___________

-respiratory rate is _______
-fever is ______ or _____

Answer 5

greater than 90b/min

greater than 20c/min

> 38 or < 36

Question 6

Have relevant specimen been collected before commencement of antibiotic therapy?

*____________ testing: blood culture, urine culture , csf culture

*Prior antibiotic use may ____________ thereby _________

*_______ antibiotic use or _____ can fuel ____________

Answer 6

culture and sensitivity

damage bacteria without killing thereby preventing growth in vitro

inappropriate; overuse
antibiotic resistance

Question 7

To aid empiric therapy

*biomarkers for infection such as ______,_______, and ________
*serum/plasma for antigen or antibody testing, PCR

Answer 7

Procalcitonin, C reactive protein , and white cell count

Question 8

gram stain can help predict useful antibiotics

T/F

Answer 8

T

Question 9

Choose antibiotics based on _______

Answer 9

lab results

Question 10

When microbiological data is now available

*Use a _____ spectrum antibiotic to treat specific pathogens

*Re-evaluate antibiotic therapy based on ________ and _______ such as organism ID and the _______

*________ or ________ based on the susceptibility result

Answer 10

narrower

clinical response and microbiological data; antibiotic susceptibility testing

streamline or De-escalate

Question 11

When microbiological data is now available

*Host factors
-____
-_______of site of infection
-age and underlying disease
-________ of illness

Answer 11

allergy

penetration

severity

Question 12

When microbiological data is now available

*Multiple antibiotic use
-risk of _________
-some antibiotics may be _____
- __________

Answer 12

adverse drug reaction

antagonistic

superinfection

Question 13

The more quickly the ————- of broad spectrum antibiotic coverage can be discontinued, the lower the risk of __________

Answer 13

selective pressures

selecting for highly resistant pathogens

Question 14

When microbiological data is now available

Other principles
* Treat ______ and not ______

• _____ before ____ of _______ avoid inordinate delay)
• ______ evaluation of appropriateness of antibiotic therapy

Answer 14

infection; colonisation

Culture; initiation of antibiotics

Daily

Question 15

When microbiological data is now available

Other principles

*___/_____ date
- Ensure all antibiotic prescription are _____

• Write _________ for antibiotic use in case notes

*Antibiotic prescription should comply with ________________________

Answer 15

Stop/review ; closed

indications (diagnosis)

antibiotic treatment guidelines in the hospital

Question 16

Advantages of IV to Oral switch

• Reduced risk of __________ infections

• No risk of ________ in case of oral administration

Answer 16

cannula-related

thrombophlebitis

Question 17

• which is less expensive between oral and IV therapy

Answer 17

Oral is Less expensive than IV therapy:

Question 18

IV to Oral switch

• Reduction in the _____ costs which mainly refer to cost of ____,______ for administration, ———,———, and ______

Answer 18

hidden

diluents, equipments

needles, syringes, and nursing time.

Question 19

In IV to Oral switch

• (Earlier or Later?) discharge
• (Reduced or Increased?) toxicity

Answer 19

Earlier

Reduced

Question 20

When doing the IV to Oral switch

Make sure the Oral bioavailability can _______________________________________

Answer 20

Achieve serum concentrations comparable to antibiotics administered intravenously

Question 21

The Golden Rules of Antimicrobial Prescribing: __________

Answer 21

MINDME

Question 22

The Golden Rules of Antimicrobial Prescribing

Answer 22

Microbiology guides therapy wherever possible

Indications should be evidence based

Narrowest spectrum required

Dosage appropriate to the site and type of infection

Minimize duration of therapy

Ensure monotherapy in most cases

Question 23

Antimicrobial resistance
• Resistance to antimicrobials is a __________ phenomenon that can be ______ by a variety of factors

Answer 23

natural biological

amplified

Question 24

Antimicrobial resistance

• The use of an antimicrobial forces microbes to ____________ in a phenomenon known as “ ____________ “

Answer 24

either adapt or die

selective pressure

Question 25

Bacteria will be killed rather than adapt T/F

Answer 25

F Bacteria will adapt rather than be killed

Question 26

Antimicrobial resistance can occur when anti-microbials are used incorrectly. - for ________ time - at _______ dose - at ______ potency - for the _____ disease • The microbes which ________ and ———- carry ________, which can be _________

Answer 26

too short a too low a inadequate wrong adapt and survive ; genes for resistance; passed on

Question 27

Antimicrobial resistance • Paradoxically, underuse through lack of _____, inadequate _____, poor _____, and substandard anti-microbials may play (equal, subpar, more?) role as overuse

Answer 27

access dosing; adherence Equal

Question 28

Total consumption of antimicrobials is a critical factor in selecting resistance T/F

Answer 28

T

Question 29

Definition of Antimicrobial stewardship • Refers to ____________ designed to ______ and _______ the ______ of antimicrobial agents by promoting the _______ of ______ antibiotic drug regimens including ______,_______, and ______

Answer 29

coordinated interventions improve and measure appropriate use selection of optimal dosing, duration of therapy and route of administration

Question 30

The antimicrobial stewardship program is a/an (formal or informal?) program that ________ and ________ the __________ of antibiotics

Answer 30

Formal Monitors and manages appropriate use

Question 31

Goals of The antimicrobial stewardship program - _______ antimicrobial therapy • right _____, _____, _____, ________

Answer 31

Optimise selection, duration, dose, route of administration

Question 32

Goals of The antimicrobial stewardship program - Reduce _______ costs • Limiting ________ and ______

Answer 32

treatment related overuse and inappropriate use

Question 33

Goals of The antimicrobial stewardship program • Promote active _________ switch therapy -Minimise adverse events - Decrease the risk of development of _________

Answer 33

IV to PO antimicrobial resistance