PC2 MOD 1.2

what are the 5 Ds of antimicrobial stewardship?

1. Diagnosis

2. Drug

3. Dose

4. De-escalation

5. Duration

Diagnosis

• is this infectious?

• what is the most likely etiology?

• what are the common pathogens for this diagnosis?

Drug

What is the best empiric antimicrobial based on etiology and antibiogram?

Dose

• What is the most efficacious and safe dose based on site of infection, renal and hepatic function?

• Does this require TDM?

De-escalation

Can we switch to a narrower spectrum antimicrobial after susceptibilities return or patient stabilizes?

Duration

• What is the shortest efficacious duration?

• How long until we can transition from IV to PO?

What are the nonspecific tests used to indicate inflammation?

• Erythrocyte sedimentation rate (ESR)

• C-reactive protein (CRP)

• Procalcitonin

• acute phase reactants: elevated in the presence of infection

  • most produced by liver

  • helps establish bacterial v non bacterial

primary prophylaxis

treatment to prevent an infectious process from developing

secondary prophylaxis

treatment to prevent infection recurrence

tertiary prophylaxis “suppression”

treatment to decrease the effects or spread of infection

What is empiric therapy in the context of infectious disease treatment?

• initial antimicrobial tx regimen based on presumptive infectious diseases

• treat suspected/most likely pathogens at the site

• consider local antibiogram resistance of those pathogens

antibiogram

aids in the selection of empiric antimicrobial regimen while awaiting culture/susceptibility results

What is targeted therapy in the context of infectious disease treatment?

• broad spectrum empiric therapy covered most likely pathogens

• once cultures and/or serological tests are available, therapy can be refined to target exact pathogens

  • narrowest spectrum

  • cost-effective

  • pt specific dose, route, frequency

What is synergy in the context of pharmacology?

synergy

• effect of using two agent is greater than the sum of the effects of the drugs

• ex: beta lactam + aminoglycoside for endocarditis

What is antagonism in the context of pharmacology?

• combination of two agents reduces the activity of each agent

• ex: bacteriostatic+bactericidal agents given together

bactericidal abx

• beta lactams

• fluroquinolones

• aminoglycosides

• daptomycin

• glycopeptides/lipoglycopeptides

• polymyxins

bacteriostatic abx

• macrolides

• tetracycline/tigecycline

• clindamycin

• linezolid

• sulfonamides

Post abx effect (PAE)

• Persistent suppression of bacterial growth after brief exposure to abx, even after drug concentrations fall below the MIC of the organism

• May allow for less frequent administration of antibiotic and still maintain adequate antibacterial activity

inoculum effect

you get much less bang for your buck w/abx

low inoculum infections: more success w/abx b/c you dont need as much exposure to kill the bugs

NARROWS

Name the issue

Ask for the reason

Reflect their emotion

Relate with personal experience

Orient to suggested management

Work together on a plan

Set follow up