antimicrobial therapy

principles of antimicrobial pharmacotherapy - REM

• reduce antibiotic resistance

• eradicate or inhibit pathogen growth

• minimize harm to the host

how to approach the principles

• use the narrowest effective spectrum (don’t want to cause futher harm)

• adjust therapy based on culture and sensitivity

• avoid unnecessary use

antimicrobial therapy appraaches - TED

1. targeted therapy:

   • adjusted after pathogen identification

   • uses narrow-spectrum agents

2. empiric therapy:

   • given based on what you think - given before pathogen identification

   • broad -

3. duration of therapy:

   • limit to the shortest effective period

antimicrobial stewardship - MOE

• minimize resistance and adverse events.

• optimize patient outcomes

• ensure cost-effective use

antimicrobial stewardship strats

• Regularly review and de-escalate antibiotic use

• Educate healthcare providers

antibiotic resistance

impact of resistance

• limits treatments options so leads to longer hospital stays and increased costs

contributors:

• overprescribing

• incomplete or improper patient use.

what are MDROs

they are multidrug-resistant organisms. they are RESISTANT TO MULTIPLE ANTIBIOTIC CLASSES - making infections difficult to treat.

• pose a serious threat to public health globally

MDROs epidemiology

• significant cause of hospital-acquired infections (HAIs)

• found in hospitals, retirement homes, and community healthcare centers

• spread through direct contact, contaminated surfaces, or devices

MDROs prevention

• strict hand hygiene

• ANTIMICROBIAL STEWARDSHIP

• environmental cleaning

• following infection control protocols

MDROs examples

MRSA, VRE, CRE, ESBL, MDR-PA, C.diff, MDR-TB

superinfections - def and cause

secondary infection arising during treatment of a primary infection

• broad-spectrum antibiotics disrupting normal flora

superinfections examples

• candida infections: abnormal discharge and pain

• clostridioides difficle: diarrhea and stomach pain

patient factors affecting antibiotic selection

immune level, allergy history, where it is, pregnancy, age, and genetics

mechanisms of antibiotic action

types:

• bactericidal agents kill bacterial directly

• bacteriostatic agents: inhibit bacterial growth

mechanisms:

• inhibit cell wall synthesis:

• inhibit protein synthesis:

• disrupt nucleic acid metabolism

• block essential metabolic pathways

antibiotic selection and indications

steps:

• identify pathogen via culture and sensitivity testing

• begin with broad-spectrum antibiotics if necessary

• transition to narrow-spectrum agents based on results

antibiotic selection and indications general guidelines -ABC

a. avoid unnecessary combination therapy

b. reserve broad-spectrum agents for severe infections

c. use shortest effective duration of therapy

goals of anti-infective therapy - SEP

support host immune system in overcoming the infection

eliminate pathogen or inhibit its growth

prevent or reduce antibiotic resistance