Antimicrobial Therapy

• What are some of the consequences of antimicrobial resistance?

  High treatment cost

  Extended hospital stays

  Low productivity rate
• What is antimicrobial stewardship?

  Set of commitments & activities designed to optimise treatment of infections, while reducing adverse events associated with Abx use

  GOALS:

  • right drug, right person, right time frame
• Start Smart then Focus algorithm

  
• Antimicrobial stewardship - surgical prophylaxis algorithm

  
• What are the different types of antibiotic use?

  Targeted therapy (definite microbiological result)

  Empiric therapy

  Prophylactic use
• What are the possible adverse events due to Abx use?

  Allergy

  Side effects

  Interaction with other meds

  Effects on normal bacterial flora -> Abx-associated diarrhoea, oral & vaginal Candidiasis, colonisation or infection by resistant bacteria

  Cannula site/central line infection

  Increased Abx resistance in community
• Suspected penicillin allergy. What should you do?

  Careful Hx of nature of the reaction

  • vague/minor (e.g. GI upset) -> can treat with beta-lactam is justified (e.g. sepsis)
  • non-urticarial rash (w/o angioedema or anaphylaxis) -> could still use if needed but with caution
  • urticarial rash or angioedema or anaphylaxis -> beta-lactams are contraindicated
• What sources can be used to look for antimicrobial advice?

  BNF

  Local antimicrobial policy

  National antimicrobial policy

  Senior colleagues

  Microbiology/Infectious Diseases