Bugs + Drugs

antibiotics are the _ most commonly prescribed drug class

2nd

inappropriate antibiotic use effects

adverse drug events

antibiotic resistance

superinfection

cost

why is antibiotic prescribing associated with excess costs?

antibiotic adverse effects are costly

main driver of antimicrobial resistance

use/overuse of antibiotics

common antibiotic mishaps

prescribing for viral infections

too broad coverage

incorrect dose + duration

which antibiotics cause QT prolongation

macrolides

fluoroquinolones

drivers of inappropriate ABX use

patient pressure

diagnostic uncertainty

failure to de-escalate

2 pillars of a targeted approach to ABX prescribing

use antibiotics more EFFECTIVELY

LIMIT unneccasry use

3 ways to use ABX more effectively

early appropriate therapy

utilize local susceptibility data (antibiogram)

consider host risk factors for resistance

3 factors to consider when prescribing ABX

-what pathogen is being targeted?

-local antibiogram

-penetration

the more ABX allergies listed in a patient's chart is correlated with _

worse infection-related outcomes

penicillin has cross-reactivity to _

cephalosporins

4 key moments of antibiotic prescribing

1. making diagnosis

2. cultures and empiric therapy

3. stop/narrow/change therapy

4 . duration

what does the MIC inform you of

the minimum drug concentration to INHIBIT growth

what does the MBC inform you of

minimum drug concentration to KILL 99.9% of bacteria

breakpoint parameter

MIC cut-off to define bacteria as S/I/R to an antibiotic

methods of susceptibility testing (4)

microboth dilution

E-test

disc diffusion

automated systems

changes needed if bacteria has intermediate susceptibility

higher dose

extended infusion

more frequent dosing

90-60 rule for antibiotics

90% of patients will respond to SUSCEPTIBLE bacteria

60% of patients will respond to RESISTANT bacteria

susceptible dose dependent

drug can be successfully treated only if higher than standard doses are used

what is antibiotic stewardship

an effort to promote best antibiotic practices

4 "rights" of antibiotic stewardship

right drug

right bug

right dose

right duration

the S/I/R breakpoints are dependent on _

MIC

primary goal of antibioitc stewardship

improve patient outcomes

antibiotic best practices (3)

ensure med orders are detailed and specific

get cultures before starting abx

reassess after 48-72 hrs

TDM should be used for which abx

aminoglycosides (gentamicin, tobramycin, amikacin)

vancomycin

antibiotics with excellent oral bioavailability (6)

metronidazole

fluroquinolones

clindamycin

TMP-SMX

linezolid

fluconazole

the _ and _ should be optimized for antibiotics

dose and route

avoid double _ coverage

anaerobic

avoid adding _ to beta lactams with anaerobic coverage

metronidazole and clindamycin

exceptions to double anaerobic coverage

C diff colitis

necrotizing skin infection

best gram negative fluoroquinolone

ciprofloxacin

fluoroquinolones examples

ciprofloxacin

levofloxacin

moxifloxacin

what characteristic of antibiotic is better for hospital acquired pneumonia

broad spectrum coverage