CD-05

Question 1

What is Antibiotic?

Answer 1

Antibiotic produced by a microorganism which inhibits the growth of other microorganisms.

Question 2

What is Antibacterial?

Answer 2

Produced by a microorganism

All antibiotics are antimicrobial but not all anti-microbial are antibiotics.

Question 3

What is the definition of Antimicrobial?

Answer 3

Substance (synthetically or biological) that inhibits the growth of microbes.

Question 4

Selective toxicity?

Answer 4

selectively kills or inhibits the growth of microbes

while causing minimal or no harm to the host. (it is an important quality for an antimicrobial drug is selective toxicity)

Question 5

With Gram negative bacteria the crystal violet is washed away leaving the red safranin dye?

Answer 5

Yes

Question 6

What acts as a virulence factor in bacteria?

Answer 6

Bacterial CAPSULES act as virulence factors

Question 7

What protect bacteria from stress?

Answer 7

Bacterial spores

Question 8

Bacteria reproduce by?

Answer 8

Binary fission (divide One body into two new bodies via asexual reproduction)

Question 9

What are the key stages of microbial pathogenesis?

Answer 9

Exposure ->Adherence->Invasion->Replication

Question 10

Which types of bacterial Cell wall mainly consists peptidoglycan?

Answer 10

Gram negative

Question 11

cell wall Peptidoglycan and Lipid?

Answer 11

Gram Negative

Question 12

Endotoxin?

Answer 12

Toxin is part of the bacteria

Question 13

Exotoxin?

Answer 13

Toxin is secreted by the bacteria

Question 14

Pathology?

Answer 14

study of causes and effects of injury

Question 15

Pathogenesis?

Answer 15

Development of a disease

Question 16

NICE Guideline means?

Answer 16

National Institute for Health and Care Excellence

Question 17

Fever in under 5s

Answer 17

Patients age under 5 years Do not use ANTIPYRETIC for sole reason of reducing fever?

Question 18

Disease of human depends on?

Answer 18

Microbes and Host so therefore treat host factors as well.

Question 19

Fever in under 5s?

Answer 19

Assessment and initial management.

Question 20

How antimicrobials are different from another drug use?

Answer 20

Abuse potential MDR

Impact on patient’s immediate community and Global community.

Question 21

Goals of antimicrobial therapy?

Answer 21

Cure a diagnosed infection (individual)
Minimise adverse events (individual)
Minimise adverse events (society) by resistance

Question 22

How We can realise Is the Patient Infected?

Answer 22

Feeling hot/cold
• Swelling, heat, or erythema
• Purulent discharge
• Sputum (cough) production (Change in amount/colour/SOB) 
• Diarrhea or vomiting
• Confusion
• Duration of symptoms 
• What has helped so far

Question 23

Body temperature for Fever is?

Answer 23

> 38°c

Question 24

Infection Signs or clinical test WCC?

Answer 24

White Cell Count Will Increase during infection

Question 25

what is ↑ CRP during infection?

Answer 25

C reactive protein Increase

Question 26

How to diagnose the sign of symptoms of infection?

Answer 26

Cultures (e.g. urine, stool, sputum) | Sputum mean a (mixture of saliva and mucus coughed up from the respiratory tract)

Question 27

What is positive culture?

Answer 27

Taking a swab Growing in your agar plates and identify the specific pathogen

Question 28

What are the Risk factors for infection?

Answer 28

* Recent surgery/procedures? * Immunosuppressed? (Medication, HIV) * Co-morbidities? (eg; Diabetes) * Recent exposure to infected individuals or sources of infection? (eg: contact tracing in COVID-19 pandemic) * Vaccination status?

Question 29

What are the Probable Sources of infection?

Answer 29

Endogenous infections:(Which is remain inside the body) E. coli UTI Staph aureus skin infections (e.g. infected IV lines)

Question 30

Exogenous infections mean?

Answer 30

Person-person, animal-person, Ex: Influenza, COVID-19, HIV (person to person)

Question 31

Is the Common Cold (Viral) or Bacterial?

Answer 31

(Viral) So, manage symptoms

Question 32

Is the Otitis Media (inflammatory diseases) of the middle ear bacterial or Viral?

Answer 32

Often Viral so Manage symptoms

Question 33

Is the Conjunctivitis viral or bacterial?

Answer 33

Both

Question 34

What is Asymptomatic UTI Viral or Bacterial?

Answer 34

Bacterial (Do not treat)

Question 35

Is the Sinusitis viral or bacterial?

Answer 35

(Bacterial): Treat if fever present

Question 36

Initiating Antimicrobial treatment what consideration I should do?

Answer 36

``` Patient symptoms (swelling, erythema) Tests results (temperature, BP, HR) Risk factors for infection (broken skin) Suspected source Antimicrobial treatment needed? Culture /swab/viral PCR Begin empiric therapy ```

Question 37

What is Empiric Therapy?

Answer 37

It is a therapy, based on experience Or on the basis of a clinical "educated guess" in the absence of complete or perfect information.”

Question 38

Guidelines for Empiric therapy for different DHBs?

Answer 38

* BPAC Antibiotic Guide * SCRIPT (ADHB) * EMPIRIC (CCDHB) * Pink Book (CDHB) * Starship (Children’s Hospital ADHB) * Micro guide (SDHB)

Question 39

Apply our JUDGEMENT before applying Empiric Therapy: 3 factors need to consider: Bug, Drug, Patient?

Answer 39

1. Infection factors (Bug) • Organism • Severity of infection: Systemic? Localised? 2. Antimicrobial factors (Drug) Spectrum of activity (broad vs narrow) • PK/PD: Distribution, Half life • Toxicity and ADR profile (risk/benefit) • Local sensitivities • Formulations available • Funding considerations ``` 3. Patient factors • Allergy status • Age – neonates, elderly • Renal function • Hepatic function • Co-morbidities (including immunosuppression) • Pregnancy/Breastfeeding • Previous antimicrobial exposure • Drug interactions • Clinical setting: inpatient/outpatient • Site of infection: eg: CNS infection vs eye infection ```

Question 40

Why we need to Narrow the antimicrobial spectrum?

Answer 40

Reduce the risk of antimicrobial resistance (AMR) and improves efficacy by selecting therapy that targets specific infective organisms Patient is clinically improving (IF NOT, aim for broader coverage)

Question 41

What is the monitoring after empiric therapy apply?

Answer 41

``` 1. Clinical improvement (Patient) • Symptoms (local and systemic) • Observations (HR, RR etc) • Physical exam (chest sounds, abdomen exam) • Bloods (CRP, WCC) • Imaging (CXR) • Possible new-onset ADRs (drug safety) 2. Therapeutic Drug Monitoring (Drug) • Serum levels • MIC-Time dependant killing • Cmax-Concentration dependant killing ```

Question 42

What would be the Duration of Treatment for Empiric therapy?

Answer 42

Most common infections have a standard treatment regimen • Refer to local guidelines Guidelines typically provide a range. This requires the use of clinical judgement. • Severity of infection • Location of infection • Drug tolerability

Question 43

What we will do if Empiric Treatment Fail to treat infection?

Answer 43

* We will check about the empiric therapy appropriate. * Appropriate spectrum for suspected organism * Dose and frequency: PKPD factors for individual patients. * Removed any contributing factors? (catheters, drains, central lines, wound debridement). * Was it truly an infection * Is there a possibility of re-infection * Was the patient compliant * Antimicrobial resistance * Review cultures

Question 44

Antimicrobial guidelines are guides?

Answer 44

To assist provision of patient care. Where Clinical judgement and patient cantered care must be applied. There is no one size fit all.

Question 45

What if non-compliance apparent what are they?

Answer 45

Pill burden Dose frequency Special instructions Intolerance etc