Lecture 21 - Antibiotic Use Flashcards by Phoebe Roper

Where does antibiotic use occur?

20% in hospital and 80% in primary care

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What % of hospital pharmacy budget are antimicrobials?

30%

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What % of antibiotic prescriptions are inappropriate?

20-50%

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What is considered a healthcare associated infection?

an infection which occurs in a patient who has been in hospital >48 hours

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What does antibiotic use increase?

the likelihood of HAI, especially in those over 65§

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What is the current HAI threat?

E coli, which originates from UTI and can lead to bacteraemia

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What is the main issue of antibiotic use?

the use of antibiotics for self liming infections caused by viruses or in some case bacteria

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What are the 5R’s of antibiotic use?

right choice

right dose

right frequency

right route

right duration

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Antibiotic use for lower UTI in female?

community

trimethoprim 200mg twice daily orally for 3 days

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Antibiotic use in severe community acquired pneumonia in hospital?

amoxicillin 500mg 3x daily IV for 5 days
+
clarithromycin 500mg 2x daily IV/oral for 5 days

review daily

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Management of URTI?

usually self limiting do don’t need antibiotics

community pharmacists give advice on symptoms relief

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What are prescribing strategies?

no prescription

delayed prescription

immediate prescription

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Acute otitis media duration?

(ear ache)

4 days

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Acute sore throat/pharyngitis/tonsilitis duration?

1 week

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Common cold duration?

1 and a half weeks

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Acute sinusitis duration?

2 and a half weeks

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Acute cough/bronchitis duration?

3 weeks

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How will a sore throat without antibiotics resolve?

40% in 3 days and 90% after 7 days

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Antibiotics use in acute cough?

reduce symptoms by only one day in an illness lasting up to 3 weeks

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Antibiotics in otitis media?

66% of children are better within 24 hours and antibiotics have no effect on symptoms

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Adverse reactions of antibiotics occurance?

1 in 16 patients

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Side effects of antibiotics?

GI effects such as nausea, vomiting and diarrhoea

serious rashes and skin reactions as well as C difficile infection

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What are patients prescribed an antibiotic in primary care for a respiratory infection at risk of?

infection with bacteria resistant to that antibiotic which may persist for up to 12 months

When are antibiotics required to treat URTI?

symptomatically very unwell - fever/chills, low blood pressure, fast heart rate or breathing

symptoms of serious complications e.g. pneumonia

Patients at high risk of serious complications?

>65 years with acute cough and 2 of the following (or >80 years and one symptom) hospitilisation in previous year diabetic cardiac failure

When to treat specific URTI?

bilateral acute otitis media in children <2 years acute sore throat/pharyngitis/tonsilitis using fever pain

What is feverpain?

fever in the past 24 hours pus on tonsil s attends rapidly (within 3 days) inflamed tonsils no cough or cold symptoms

What does a feverpain score of 4 or 5 suggest?

high chance of streptococcal infection

When to use antibiotics for other infections?

when there are clear signs of infection such as raised temperature raised blood pressure and/or heart rate increased respiratory rate - chest infection pain, redness, swelling, skin infection

What might blood pressure be in a severe infection?

low

What should be advised to patients for symptom relief?

fluids, rest, simple analgesia (paracetamol or ibuprofen)

What are the two key elements used to promote appropriate antibiotic use?

guidance/policies for clinicians on use of antibiotics education of healthcare staff, patients and public

What do antimicrobial prescribing guidelines give?

evidence based guidance on empirical treatment of common infections

What do antimicrobial prescribing guidelines promote?

use of narrow spectrum agents and restrict broad spectrum agents and those associated with high risk of C difficile infection

What is most antibiotic therapy?

empirical - best guess at likely infecting organism

What is empirical therapy usually?

broad spectrum

When should directed antibiotic therapy be used?

if you know the causative organism

What are the most common types of infection in hospital and primary care?

respiratory - URTI, exacerbation COPD, pneumonia urinary - lower, upper (pyelonephritis) skin & soft tissue - cellulitis, wound infection, diabetic ulcer

What does the severity of the infection indicate?

where it is managed GPs have clear criteria for when to refer to hospital

What are there other policies for in hospitals?

surgical prophylaxis IV to oral switch (IVOST) protected/alert antibiotics specialist unit policies e.g. haematology, renal gentamicin and vancomycin

Who should be trained in antimicrobial stewardship?

all staff who prescribe, monitor or administer antimicrobial therapy

How is education for healthcare staff done?

hospital based induction sessions for new staff GP practice based education for GPs and other prescribers public education is also important

How is pharmacist training and education done?

pre-registration training specialist training NES hosted learning sessions aimed at community pharmacists delivered in every NHS board 2018-19 training hosted by RPS

What kind of specialist training do pharmacists get?

antimicrobial pharmacist intensive training pharmacokinetics of gentamicin and vancomyin training

Nursing staff educational acitivities?

TDM antibiotics, IVOST poly, Alert Antibiotics

Medical staff education activities?

safer use of TDM antibiotics, antibiotic policies

Hospital pharmacy staff educational activities?

alert antibiotics, MRSA eradication, hand hygiene, audit results

Why measure things?

Lord Kelvin - to measure is to know to improve something you need to measure it

What are antimicrobial resistance trends?

Show resistance to key antibiotics in common pathogenic organisms monitored

What do samples from microbiology labs in hospitals generate?

reports which are collated at local and national level also monitor for new resistance emerging in alert organisms

What are a major emerging threat?

multi resistant gram negative organisms

How are MRGN spread?

international travel, particularly medical tourism

What can resistant strains of E coli or klebsiella cause?

bacteraemia, UTI, intra-abdominal infection os respiratory tract infection

What is the latest threat?

carbapenemase producing enterobacteriaceae

What are diagnostics?

major changes in time for identification of bacteria and sensitivity to antibiotics whole genome sequencing point of care tests

What is the role of prescribers in antibiotic use?

nurses and pharmacists have increasing role

Covid-19 antibiotic use?

is a viral illness which for most patients is a mild, self limiting infection empirical antibiotic therapy if required for suspected bacterial infection should be used in line with routine guidelines