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Flashcards in Antibiotics, prescribing & infection control Deck (15):

Define antimicrobial stewardship

Appropriate use of antibiotics in order to optimise clinical outcomes minimise unitended consequences of antimicrobial use (toxicity, selection of pathogenic or resistance organisms)


Why is antiimicrobial stewardship important

Effect on patients: Clinical outcome, length of stay, Hospital acquired infections

Effect on hospitals: Bed management, morbidity/mortality, cost

Effect on the NHS: Cost, resistance


Name 3 healthcare associated infections associated with antibiotic use

C. difficile - ciprofloxacin

MRSA - flucloxacin, broad-spectrum penicillins

ESBL - broad-spectrum penicillins 

VRE - use of vancomycin in renal units


Key things to take into account when deciding whether or not to prescribe an antibiotic?

Previous microbiology
Appropriate route of administration
Source of infection
Likely pathogens
Antibiotic policy
Need for senior advice


When prescribing an antibiotic, what must you include on the kardex?

Indication for use, drug, dose, administration, review date


How soon should you start antibiotics in a patient with life-threatening illness?

Within the first hour

Responsibility of the Dr who first sees the patient to administer the first IV dose. 


N.B. Cultures taken first! 


When shoud IV antibiotic administration be reviewed?

After 48hrs. 

Switch to oral, narrrow spectrum or OPAT (outpatient, parenteral antibiotic)


Factors that lead to increased risk of resistance

Inappropriate use of antibiotics

Poor infection control

Excessive antiiotic use in non-clinical settings 


Give three examples of how antibiotics lead to HAIs (describe)

C. diff: prolonged use of antibiotics disrupts the normal flora allowing colonisation of C.diff leading to diarrhoea

MRSA: normal flora eradicated allowing colonisation of the skin with MRSA which can go on to cause infection

ESBL: following broad spectrum antibiotic use strainsa re selected out and persist, can cause infection 


When are antibiotics used prophylactically?

Given to prevent infection before surgery (e.g. graft/prosthesis, dirty operation - pus, bowel contents)

In patients prone to particular infections

In patients who are specifically immunocompromised


Antibiotics are targetted to the most likely pathogens, duration kept to a minimum to reduce the chance of resitance


What is targeted antibiotic therapy?

Wen the infection and causative organism are known

Best way of effective treatment because the sensitivity of the pathogen can be determined


What is empiracal antibiotic therapy?

Antibiotic given without knowing the causative organism

Choice basd on practical experience, EBM. Therapy used to cover all possibilities until cause is determined. 


Antibiotics which are not excreted in the urine






Standard infection control precautions

Hand Hygiene
Safe use of Sharps
Protective Clothing
Clinical Waste Disposal


Prevention of C. difficile infections in hospital

Reduce antibiotic use generally
Reduce specific antibiotics (cephalosporins and ciprofloxacin)
Isolate infectious patients
Treat infected patients to reduce diarrhoea
Clean the environment

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