Flashcards in Antibiotics Prudent Use Deck (14)
What was the usage of antibiotics in humans and animals in the EU in 1997?
52% human use
33% animal therapeutic use
15% animals (as feed additive)
How does resistance to fluoroqinolones change depending on whether it was licensed for poultry and livestock?
It increases if it was licensed but in Australia there's low resistance as it wasn't licensed there so never used in agriculture.
What are the consequences of inappropriate prescribing?
Side effects: rash, anaphylaxis etc
Antibiotic-associated diarrhoea (non c.difficile associated)
Clostridium difficile associated diarrhoea (CDAD)
What is the prudent use of antibiotics?
-prescribe therapeutic antibiotics only for clinically significant bacterial infections
-prescribe prophylactic antibiotics according to evidence based guidelines (eg NICE guidelines)
-use narrowest spectrum AB appropriate for the infection
-use shortest course poss
-use single dose AB prophylaxis for surgical procedures
What strategies can be used to improve AB prescribing?
-education and training
-restricted lab reporting of AB sensitivities
-audit of antibiotic use
-feedback to prescribers
-'AB ward rounds'
What does laboratory reporting do?
It interprets the significance of culture and sensitivity results by microbiologists. Therefore the most appropriate and narrowest spectrum available AB can be chosen to steer prescriber towards the appropriate agent and away from unnecessary broad spectrum choices.
What are antibiotic guidelines?
Produce evidence based AB guidelines. It's a comprehensive cover of a full spectrum of infections. It's detailed and accessible (novel approaches-bleep sticker)
What are antibiotic pharmacists?
They play a lead role in coordinating production of new AB guidelines and timely review and update of existing guidelines. Lead role in education in appropriate AB prescribing. Lead role in audit of AB prescribing, feedback to users and development of strategies to improve practices.
What does an audit of AB's achieve?
Compliance with existing local guidelines. Provides feedback to users on compliance rates and on antibiotic consumption data linked to adverse outcome data.
What are AB ward rounds?
Ward rounds if poss involving AB pharmacist, microbiologist and IT expert. Reviews AB prescriptions with feedback to prescribing teams recommending changes where appropriate eg iv to oral switch, stop therapy etc.
How can you control MDR (multiple drug resistant) bacteria?
Timely identification (screening) and infection control measures. Isolation of patients with AB resistant organism.
What is start smart?
don't start AB's in the absence of clinical evidence of bacterial infection and use local guidelines to initiate the promo effective AB treatment. Document on drug chart and in notes: clinical indication, duration, review date, route and dose. Obtain cultures. Prescribe single dose ABs for surgical prophylaxis where they've been shown to be effective.
What's the antimicrobial prescribing decision?
A clear plan of action by 48 hours after clinical diagnosis: options:
Stop, switch iv to oral, change, continue and outpatients parenteral antibiotic therapy.
Review and decision made must be clearly documented.