Empirical and targeted application of antimicrobial agents

Factors to wait on Rx pending culture results

Stable, low risk/self limiting/non-painful

Factors that favor empirical therapy while waiting for culture results

Critically ill patient, septic or pre septic patients, rapid progression, pneumonia, reccurent UTIs

Factors that favor empirical treatment with no culture

Sporadic UTIs, acute wounds/open fractures, newly presenting pyoderma, actute keratitis, otitis externa

Big maybes

diarrhea in companion animals, watch and wait vs equine always culture

Organisms wehre resistance is of particular concern in vet med

Enteric gram negatives (Ecoli, Klebsiella spp, Enterobacter spp, Salmonella), Staph, Pseudomonas aeruginosa, Bovine resp. pathogens

What are the bovine respiratory disease pathogens

Mannheimia haemolytica, Pasteurella multocida, Histophilus somnii

Antibiograms show what?

Resistence trends

De-escalation is a key stewardship principle, what are some of the key points?

Empirical treatment that is later informed by antibiotics should become more narrow based on lab data, d/c additional antibitotics or coverage for things outside of pathogen you are sure about

90-60 rule

90 percent of infections with proper antibiotics will improve, 60 percent of infections treated with inappropriate antiboitcs will also improve due to immune system