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Flashcards in 243 Antimicrobial Stewardship Deck (40)
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0
Q

Where are anaerobes usually found?

A

In the mouth, teeth, sinuses, lower bowel

Cause abscesses, dental infections, peritonitis, appendicitis

1
Q

How can we determine the severity of a chest infection?

A

Use curb 65 score
Tells you whether the person can be treated at home, needs hospital supervised treatment, or needs to be managed in hospital

2
Q

What are the 6 steps to go through with the antibiotic prescribing decision process?

A

1) diagnosis, rate the severity
2) pick an agent (informed by empirical guidelines, or Mc&S
3) route of admin- IV or oral? Depends on severity
4) dose- based on patient factors
5) duration and review date- IV-oral switch?
6) monitoring- how can we tell if the patients getting better?

3
Q

What are some advantages of MC&S guided therapy?

A

We can find out what’s causing infection
So we know what to treat it with
Treatment should be more successful
Narrow spectrum antibiotics- less s/es, less risk of nosocomial infections
Can use targetted antibiotic therapy

4
Q

What two antibiotics are nephrotoxic?

A

Gentamicin

Vancomycin

5
Q

What class of antibiotics are contraindicated in epilepsy?

A

Quinolones
Eg. Ciprofloxacin
These lower seizure threshold
Also interact with phenytoin

6
Q

What two antibiotics should not be used in hepatic impairment?

A

Rifamicins

Fucidin

7
Q

Which type of allergic reaction involves IgE antibodies?

A

Type I “ allergic immediate”

Anaphylaxis, onset in one hour

8
Q

Which type of allergic reaction involves IgG and IgM antibodies?

A
Type III 
Takes over 72 hours to onset 
Immune complexes involved
serious reaction 
Purporea rash
9
Q

Warning! Any patient with a history of ___ mediated allergic reactions should not receive a penicillin!! 

A

IgE mediated

Penicillin ABs include: amoxicillin, ampicillin, flucloxacillin, augmentin, piptazo etc

10
Q

Are other/ idiopathic allergies considered “true allergies?”

A

No.

Occurs in 1-4% patients receiving penicillins and cephalosporins

11
Q

What is C diff caused by?

A

Overgrowth of anaerobic bacteria in the gut
Opportunistic
Associated with previous antibiotic administration/ over use of antibiotics with a broad spectrum

12
Q

What do macrolides interact with, and why?

A

Warfarin
Statins (cause muscle wastage)

This is because they’re CYP3A4 inhibitors therefore they increase the levels of these drugs

13
Q

What does RIFAMPCIN interact with, why?

A

Warfarin
Theophylline
Progesterones-COC, POP

It’s a potent inducer of CYP450 enzymes
Increased metabolism of drugs metabolised by these enzymes

14
Q

When should IV (parenteral) antibiotics be reviewed?

A

After 48 hours of initiation

Review to see if we can change to a narrower spectrum AB as microbiology have come back to us
Or review to switching to ORAL
But certain conditions must be met before switching to oral antibiotics

15
Q

What patients conditions should be met before switching to oral antibiotics?

A

Temperature below 37.5 for 24 hours
Conditions improving or stabilising
Signs and symptoms improving
Decreasing ESR/ CRP/ WBC
No potential absorption problems with oral
Is there a suitable oral formulation available
Shouldn’t be suffering from a high risk infection

16
Q

Who is involved with SURVEILLANCE of antibiotic usage over Europe?

A

European centre for disease prevention and control (ECDC) (EARS-net: European antibiotic resistance surveillance)
Monitors antibiotic usage and incidence of resistance/ HCAI’s

17
Q

Is pyelonephritis considered a high risk infection? Can the IV-oral switch be done?

A

No

Yes it can be switched

18
Q

What is the oral bioavailability of ciprofloxacin?

A

100%

Therefore it’s fine to switch to oral

19
Q

Is osteomyelitis considered high risk? Can an IV- oral switch be done? Why?

A

Yes
IV oral switch can’t be done
Don’t get enough penetration into bone orally

20
Q

Is meningitis considered high risk? What about endocarditis?

A

Yes both

Don’t switch to oral

21
Q

Is gangrene considered high risk?

A

Yes

22
Q

Is community aq and hospital aq pneumonia considered high risk?

A

No

IV to oral switch can be done

23
Q

Is severe cellulitis considerd high risk?

A

Yes

Don’t consider switching unless really have to

24
Q

What is mediastinitis?

A

An infection/ inflammation of tissues in the chest

It is considered high risk

25
Q

When do we monitor peak levels and when do we monitor trough levels in Gentamicin dosing regimens?

A

O.d or B.d dosing= monitor trough levels only

For t.d.s dosing (with MRSA or endocarditis) monitor both peak and trough levels

26
Q

What is the desired range of trough levels for gentamicin?

A

Less than 1 mg/ L

27
Q

What’s the main bacteria causing UTIs?

A

E.Coli

28
Q

What’s the main bacteria causing CAP?

A

Streptococcus pneumonia

29
Q

What are the 2 main types of bacteria causing Cellulits?

A

Streptococcus (B-heamolytic streptococci)

Staphylococcus

30
Q

HAP is usually caused by gram ______ bacilli

A

Negative

Common causes:
Enterobacteriacea
Pseudomonas
Acineto bacter
Staph aureus
Legionella
31
Q

Renal impairment and gentamicin: what’s the deal?

A

Can still use it in renal impairment BUT consider Piptazo (piperacillin with tazobactam)
If severe renal impairment use Piptazo

Remember gentamicin needs therapeutic drug monitoring

32
Q

What’s the formula for ideal body weight and when in antibiotics is it used?

A

Men: 50 kg + 2.3kg per inch over 5 feet
Women: 45.5kg + 2.3kg per inch over 5 feet

Used to work out corrected weight which is used for obese patients when working out their gentamicin dose!

33
Q

What’s the formula for corrected body weight then, used for working out dosing of gentamicin in patients that are obese?

A

Corrected weight = Ideal body weight + [0.4 X (actual body weight - ideal body weight]

34
Q

If a patient is over 70, what should be the starting dose of gentamicin? What is it usually?

A

4 mg/kg once daily

Usually it’s 5 mg/ kg

35
Q

Gentamicin doses should be rounded DOWN to the nearest multiple of ___mg

A

40 mg

This is because ampoules come as 40mg!- easier dosing

36
Q

The starting dose of vancomycin in patients with normal renal function is based on what?

A

Age

Less than 60= 1 mg b.d
60-75= 750 mg b.d
Over 75 = 509 mg b.d

37
Q

When should the initial pre dose level ( first blood sample for drug levels) be taken for Vancomycin?

A

Initial pre dose should be taken before 3rd or 4th dose

Level should be taken 11-12 hours after previous dose for b.d dosing, within one hour before next one is due

38
Q

When taking blood samples for drug levels, how much should be sent?

A

Send 3.5ml blood in a yellow top (SST) tube

Write time sample taken
Write words PRE dose

39
Q

When looking at the antibiotic guidelines, do we usually have neutropenic or non neutropenic sepsis?

A

Non neutropenic

Neutropenic is just for cancer patients with low neutrophils

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