抗生素ppt课件（英文精品）antibiotic senior academic half

Coventry and Warwickshire Pathology Antibiotic Senior Academic Half Day Matt Rogers it is highly effective in preventing infection, but can promote resistance. Limit to those individuals in whom the risk of infection is high. Coventry and Warwickshire Pathology Principles of antibiotic prophylaxis Which antibiotics? should be targeted to the most likely pathogens. When? administration as near the time of incision as possible. Intravenous antibiotics should be given during the induction of anaesthesia with repeat doses for longer procedures. Duration: keep to a minimum (often even to a single-dose) to reduce the chance of resistance developing. The benefits of post-operative prophylaxis lasting more than 12 h have not been proven. Coventry and Warwickshire Pathology Indications for antibiotic prophylaxis Contaminated or dirty operations presence of bowel contents, pus, or infected foreign material Insertion of graft or prosthesis where development of infection would be serious. Immunocompromised patients Patients with cardiovascular abnormalities, may require specific antibiotic prophylaxis to reduce the risk of endocarditis (NICE guidelines, BSAC guidelines) Coventry and Warwickshire Pathology Risk Factors for Surgical Site Infection Patient: Extremes of age Poor nutritional state Obesity Diabetes mellitus Smoking Co-existing infections at other sites Bacterial colonisation (e.g. MRSA) Immunosuppression Prolonged postoperative stay Operation Length of surgical scrub Skin antisepsis Preoperative shaving Preoperative skin prep Length of operation Antimicrobial prophylaxis Operating theatre ventilation Inadequate instrument sterilisation Foreign material in surgical site Surgical drains Surgical technique including haemostasis, poor closure, tissue trauma Postoperative hypothermia Coventry and Warwickshire Pathology SIGN: Scottish Intercollegiate Guidelines Network www.sign.ac.uk www.sign.ac.uk/guidelines/fulltext/104/i ndex.html SIGNqrg104.pdf Coventry and Warwickshire Pathology Empirical therapy Therapy given without knowing the causative organism Choice based on practical experience and evidence based medicine Best guess therapy, unlikely to cover all possibilities Coventry and Warwickshire Pathology Targeted therapy Therapy given when the infection and causative organism is known This is the best way of effective treatment We should know the actual sensitivity of the offending pathogen Coventry and Warwickshire Pathology What - Considerations in therapy Choice of agent includes: Recent DOH guidance (Clostridium difficile) Has altered policies Range of pathogens (Why?) Infection site/drug penetration Patient factors (allergy) The above should be covered by your antibiotic policy Combination therapy (synergy/antagonism) Dose/Frequency Route IV/oral IV/oral switch Duration (5-7 days for most infection) Coventry and Warwickshire Pathology Patient factors Allergy Other medications (interactions) Can they take PO Tolerance Compliance Coventry and Warwickshire Pathology Infection site Drug penetration e.g. Antibiotics arent always the answer Infection prostheses - SURGERY Bone/Soft tissue infections Some drugs like the aminoglycosides do not penetrate well Meningitis Many drugs will not penetrate CSF well Coventry and Warwickshire Pathology IV or oral What are the considerations Depends on site of infection Oral bioavailability of the antibiotic Clear aim/end point (treatment/suppression) Licencing Coventry and Warwickshire Pathology MAU Audit Zoe Campbell F2 SHO Only those with Severe pneumonia according to CURB criteria should receive IV antibiotics 18 out of 25 patients received IV antibiotics 18 patients were classified mild/mod (? Oral antibiotics) 7 patients were classified severe (? IV antibiotics) I.V. Oral Mild/ Moderate Severe Coventry and Warwickshire Pathology MAU Audit: IV/Oral Switch Only 2 out of 25 (8%) patients had an IV to oral switch or a review/stop date specified on initial clerking No date specified Date specified Coventry and Warwickshire Pathology Also How much? Unfortunate but Healthcare economics are always a consideration Particularly with some newer drugs Antifungals Antibacterials Antivirals Coventry and Warwickshire Pathology No antibiotic option Our antibiotic options are running out. Increasing resistance Paucity of new drugs Avoid unnecessarily antibiotics Often there to make us feel better rather than the patient! Unnecessary risk to patients Look for 1 marker of infection Stop antibiotics as soon as possible Plan stop dates / review dates Coventry and Warwickshire Pathology Coventry and Warwickshire Pathology What must an antibiotic prescription includ