Flashcards in Management of common infections Deck (13)
What does antibiotic stewardship mean?
Sensible antibiotic prescribing (often with guidelines)
Why is antibiotic stewardship important?
- Antibiotic resistance
- Adverse effects of antibiotics
- Antibiotic cost (and cost of side-effects)
Why has antibiotic resistance arisen
- Injudicious use of antibiotics (hospitals, GPs and argiculture)
- Inherent property of micro-organisms (easily able tospread genes)
- Lack of investment from big pharma (as soon as a new antibiotic is released it has to be tightly regulated)
What percentage of patients suffer from adverse effects from antibiotics?
~ 20% (includes allergy, side-effects, C diff)
What may fever and elevated CRP indicate other than infection?
- Drug fever
- Blood in the wrong place (thrombus or haemorrhage)
Why if a bug is grown in the lab may the patient sometimes not be treated?
- The bug may not be causing any damage - may just be part of normal flora
- Have to ensure it is a decent sample (pus as opposed to swab) and not contaminated
What does uni pus, ibi evacua refer to?
- Where there's pus, let it out
- Also if there is a foreign body causing infection, remove it
- If there is non-viable tissue, debride it
What factors must you consider when considering the correct length of time to presrcibe the antibiotic?
- How well does the antibiotic penetrate the target tissue
- How rapidly does the microorgansim multiply
- Guide by progress
What are some of the factors that could be the reason for a patient to not respond to the antibiotic?
- Is it the right antibiotic (resistance, re-culture)
- Is the antibiotic getting where it needs to go
- Is the antibiotic being presrbed at the right dose
- Is it being administered via the corret route
- Has 'source control' been achieved (remove bulk of infection e.g drain pus, remove prosthesis)
- Is the problem really an infection
When is combination therapy useful?
- Emperic abx (cover more bases)
- Synergistic abx (e.g gentamycin with Beta lactam in strep IE)
- To prevent resistance (TB, HIV, S. aureus)
- Mixed infection
What are the 3 main causes of pyrexia of unkown origin?
- Connective tissue disease
Causes of PUO