Infectious Diseases - 2
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- Created by: LBCW0502
- Created on: 15-11-19 12:05
Which factors are considered when choosing an antimicrobial agent?
Patient factors, drug factors, organism factors
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Give examples of patient factors (1)
Allergies, age, concurrent medications/interactions, recent treatments, site of infection, routes available, sensitivites, renal function, co-morbidities, disease severity, epidemiology/travel/sex/pets/occupation, likely pathogens, Gram stain
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Give examples of patient factors (2)
Tetracyclines (deposited in growing bone/teeth, discolouration, not used in children). Quinolone (affect tendon/bone growth development, not used in children)
3 of 20
Give examples of patient factors (3)
C. difficile (overgrowth of organism in gut, severe diarrhoea, linked to overuse of broad-spectrum antibiotics, affects elderly)
4 of 20
Give examples of patient factors (4)
Compromised immune system e.g. diabetes, HIV, cancer, long term steroid use. Renal impairment (renal clearance e.g. beta lactams, either sufficient levels or toxic levels). Nephrotoxic drugs e.g. gentamicin. Pregnancy/breastfeeding, patient weight
5 of 20
Give examples of patient factors (5)
Site of infection - may need to cross BBB in right concentrations e.g. meningitis. Tolerability/compliance (oral or IV)
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Give examples of drug factors (1)
Class, PK, formulation, MOA (cidal/instant kill or static/reduce numbers), ADRs/ADEs, resistance, dosing regimen/compliance, sensitivities, interactions, PD, co-morbidities, indications/licensing, spectrum of action, contra-indications
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Give examples of drug factors (2)
Other medications (potential drug interactions). Rifampicin (CYP enzyme inducer), increase metabolism of other drugs (reduce plasma levels) e.g. warfarin, anti-epileptic drugs
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Give examples of drug factors (3)
Drugs can inhibit CYP enzymes e.g. isoniazid (increase F of drugs, risk of toxicity) e.g. clarithromycin, ciprofloxacin. Prior antibiotic history. Recurrent UTI (could be due to co-morbidities). IV antibiotics (reach systemic circulation fast)
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Give examples of drug factors (4)
Different ways of giving IV drugs e.g. infusion, bolus. ADRs e.g. ciprofloxacin can reduce seizure threshold (risk in epilepsy).
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Give examples of organism factors
Surveillance investigations when patient is admitted (colonisation vs infection)
11 of 20
What are the principles of antimicrobial usage? (1)
Diagnosis (history, examination, investigations). Which organism. Choice of antimicrobial agent (empiric, directed, combination). Empiric (best guessed therapy based on patient presentation, common cause)
12 of 20
What are the principles of antimicrobial usage? (2)
Direct therapy (know organism causing infection from blood cultures). Combination (single drug might not cover all organisms). Don't assume organisms grown are involved (not all significant, flora)
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What are the principles of antimicrobial usage? (3)
E.g. deep tissue sample, treat all organisms present, no flora should be in deep tissue)
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Describe features of the choice of dosing regimen (1)
Dose (patient size, organ function, severity of illness, site of infection, PK/PD, infecting organism (MIC), therapeutic index. ROA (same factors). Method of administration (site of infection, PK/PD, MIC). Frequency (site of infection, PK/PD, MIC)
15 of 20
Describe features of the choice of dosing regimen (2)
Duration of therapy (shorter is better)
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What are the aspects of PK and PD?
PK - ADME, PD - pharmacological/toxic effect, antimicrobial effect over time (diagram). Link with MIC, PK, dose and drug effects (diagram, graph)
17 of 20
State features of infection control
Staff measures (standard principles, routine hand washing/use of alcohol gels and foams). Protective clothing where necessary, adhere to aseptic technique. Ensure immunisation. Visitors - medical/surgical staff and students visiting
18 of 20
State features of minimising cross-infection (1)
Identify MRSA/VRE/CRO carriers. Consider isolating infected/colonised patients and using barrier nursing. Consider other sources if infection spreads. Follow good practice guidelines for changing disposables
19 of 20
State features of minimising cross-infection (2)
Regular education and input from infection control staff. Regularly review resistance rates (revise guidance). Antibacterials/beta lactams (slide). Bacteria (Gram +/-, mycoplasma), slide
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Other cards in this set
Card 2
Front
Give examples of patient factors (1)
Back
Allergies, age, concurrent medications/interactions, recent treatments, site of infection, routes available, sensitivites, renal function, co-morbidities, disease severity, epidemiology/travel/sex/pets/occupation, likely pathogens, Gram stain
Card 3
Front
Give examples of patient factors (2)
Back
Card 4
Front
Give examples of patient factors (3)
Back
Card 5
Front
Give examples of patient factors (4)
Back
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