Basic principles of Antibiotic use

Question Answer
Increase in neutrophils indicates either Bacterial or fungi infection
Lymppcyte elevation indicates a Viral infection
Monocyte elevation can indicate Infection with Listeria monocytogenes or M. tuberulosis
Eosinohil elevation can indicate Allergic reaction, or parasitic infection
Basophil elevation can indicate an Allergic response
Left shift is a Increase in neutrophils,and bands and lympocytes, and monocytes
Factors involved in determining the most likely organism Site of infection, method of acqusition(hospital or community) Patient specific information (Age, Immune status, underlying illiness, previous antimicrobial therapy, & previous Ab therapy-dose,duration)
Patient factors influencing potiential pathogens Age, pre-existing disease, other conditions (indwelling catheter, steroid therapy, surgery of urinary tract)
Goals of antibiotic therapy Cure the infection (most eradication), supportive care, prevention of infection
Best antibiotic rules of thumb activity & efficacy against suspected or known pathogen- narrow efficacy, bactericidal, low resistance
11 Steps of antimicrobial therapy 1.Is Antibiotic indicated 2.Clinical specimens 3.Organism 4.Goals of therapy 5. Best antibiotic 6.Combo therapy 7.Route of administration 8. Appropriate dose 9. Duration of therapy 10. Monitor 11.Reason of clinical failure
Best antibiotic determined by Age, allergies, prior ABX, immunosuppression, prostetic devices, concurrent disease states, renal and hepatic function, site and severity of infection, penetration to site of infection, routes of administration, compliance issues
Pregnancy and lactation recommendation PCN, cephs, erythro base, azetronam, Caution: AG, vanco, clinda, imipenem/cilastatin, TMP
Best Antibiotic characteristics PK, SE, compliance, Cost
Emergence of drug resistance SPACE M Serratia Psedomonas, acinetobacter, Cintrobacter, Enterobacter, mycobacerium tuberculosis- used combination therapy
Critically ill alterations are Immunologic failure, respiratory failure, renal failure, endothelial failure, endocrine dysfunction, neuromuscular dysfunction, cardiovascular failure, CNS dysfunction, Hepatic dysfunction, GR failure- these all effect antibiotic selection
Needs for combination therapy Mixed infection, or need for synergy against P. aeruginson, wnterococcus, or staphylococci
Route of Administration Mild infection-topical or oral Moderately severe infection- oral or IV/IM Severe infection IV therapy
Duration of therapy Poorly defined in ID, dependant of organism, location, host, response to therapy, AB selection, and comfort level
Disadvantages of Combo therapy Increased: resistance, risk of superinfection, toxcities, potential for drug interactions, increase in cost
Appropriate dose therapy Lozest dose of antibiotic that will provide desired effect via PK/PD, aggressive dosing required in many clinical situations
Efficacy parameters WBC with diff= Absolute WBC increase, increase in bands and segs, gram stain and culture results
Monitoring parameters VS, temperature, Bp, erythema, swelling, discharge, myalgia, arthralgia, heart and respiratory rates, history of illiness
Other efficacy parameters Chest radiograph, CT scan, MRI, erythrocyte sedimentation rate, C-reactive protein, PTL, Group A test, seriologic antibody test-HIV chlamydia
Monitoring paramaters for safety of therapy Subjective reports/complaints, PE, Labs, drug toxicities, drug interactions, compliance issues

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