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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?

- Pancreatitis
- Drug fever
- Malignancy
- 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?

- Infections
- Malignancies
- Connective tissue disease


Causes of PUO



Prognosis for patients with PUO?

- 70% get better
- 25-30% have on-going symptoms
- ~ 3%