Delivered by: Jennifer Dodd Lead · PDF fileDelivered by: Jennifer Dodd . ... What is...
Transcript of Delivered by: Jennifer Dodd Lead · PDF fileDelivered by: Jennifer Dodd . ... What is...
In the next 30 minutes
How to access the Antimicrobial Formulary
What is expected for every antibiotic
prescription
MCQs
Audit
What antibiotic information is available?
Antimicrobial Formulary for adults (plus summary)
and paediatrics available on the Intranet
Vancomycin and gentamicin dosing guidelines
Surgical prophylaxis guidelines
Contact consultant microbiologists for antibiotic
advice
Ward pharmacists
BNF
Antimicrobial Formularies
Antimicrobial Formularies
Contents page – Hyperlinks to empiric treatment for each type of infection
Lists ‘High risk C difficile antibiotics’, and risk factors
C Diff treatment - also CDI policy
Principles of good antimicrobial prescribing
Restricted antimicrobial list: Red, Amber
Tips….
Change from IV to oral guide
Microbiological specimens
Management of MRSA
Dosing in Renal Impairment
Vancomycin/gentamicin guideline
Antimicrobial prophylaxis post-splenectomy
Antibiotic Prescribing Tips
Allergy box completed
Antibiotic, route, dose and frequency
Review date at 48 hours/72 hours
Stop date (5 days if empiric)
Use the shortest duration of treatment suitable for the infection
Indication recorded on prescription chart, as well as medical notes
IV antimicrobials review after 48 hours – to oral?
Printed Name and bleep number
Gentamicin monitoring
80 year old male, 80kg (not obese)
Urosepsis
Creatinine 112micromole/L (CrCl 53ml/min)
Gentamicin level at 9:00am 2/1/12 = 3.1mg/l
What do you do?
Gentamicin monitoring
Taken too early - insignificant
Should be taken 1-4 hours before the 2nd
dose
Repeat level at ~6-9pm
Nursing to document time of administration
and time of sample in the medical notes
GDH + & C. Difficile + Patients
GDH – Glutamate Dehydrogenase
GDH –ve
GDH +ve + C. Diff toxin –ve
GDH +ve and C. Diff toxin +ve
Key top interactions…
Antifungals/quinolones/rifamycins – LOTS of
interactions!
Most antimicrobials – Warfarin
Macrolides/Daptomycin/Fusidic Acid –
Statins
Daptomycin – Measure CK
Trimethoprim – Methotrexate
Aminoglycosides – IV diuretics
Question 1
Which ONE of the following is the most likely pathogen in Community acquired pneumonia?
a) Streptococcus pneumoniae
b) Pseudomonas aeruginosa
c) Moraxella catarrhalis
d) E.coli
e) Streptococcus pyogenes
Question 2
Which ONE of the following is the most
likely pathogen in exacerbation of COPD?
a) Streptococcus pneumoniae
b) Staphylococcus aureus
c) Haemophilus influenzae
d) Anaerobes
Question 3a
A 78 year old lady is admitted to hospital
with SOB, and coughing up green sputum.
CXR showed right basal consolidation.
Ur: 8.8, BP: 80/40, AMT: 10, RR: 23.
What is the severity of this patient’s pneumonia?
a) Mild
b) Moderate
c) Severe
Question 3b
For the same patient, what antimicrobial
treatment would you commence them on?
(Patient has no known drug allergies)
a) IV Co-amoxiclav + IV Clarithromycin
b) Oral Amoxicillin alone
c) Oral Amoxicillin + Oral Clarithromycin
Question 3c
For the same patient, which of the following
Microbiological specimens should you take?
a. Pneumococcal urinary antigen
b. Legionella urinary antigen – after speaking
to microbiologist
c. Blood culture
d. Sputum sample
e. All of the above
Question 3d
The first results that come back for the patient are Pneumococcal Ag +ve, Legionella Ag-ve, what changes could you make to the patient’s treatment, if any?
a) Continue with same regimen
b) Stop IV Clarithromycin
c) Switch IV Co-amoxiclav to oral Amoxil
d) IV to oral switch for both Co-amoxiclav and Clarithromycin
Question 4
A patient is admitted with non-severe cellulitis and has a MRSA screen, the screen is positive. What antibiotic treatment would be appropriate?
a) Doxycycline
b) Flucloxacillin
c) Clarithromycin
d) Cefalexin
Question 5
Which of the following antibiotics are high-
risk for precipitating C. difficile infection?
a) Co-amoxiclav
b) Ciprofloxacin
c) Ceftriaxone
d) All of the above
Question 6
Which ONE of the following is a risk factor
for Clostridium difficile infection?
a) Morphine sulphate
b) Loperamide
c) Omeprazole
d) Paracetamol
e) Dalteparin
Question 7
A patient is receiving IV Vancomycin 1g OD for a
MRSA wound infection, your SHO asks you to switch
to oral treatment. Which of the following is the most
suitable action?
a) Sodium fusidate 500mg po tds
b) Rifampicin 600mg po bd + Doxycycline 100mg po bd
c) Vancomycin 250mg po qds
d) Flucloxacillin 500mg po qds
e) Contact microbiologist
Question 8
A patient is receiving Vancomycin 1g IV bd, a pre-dose level is taken before the 4th dose, the level is 25.0mg/L, what action would you take?
a) Continue with current regimen
b) Stop IV Vancomycin
c) Reduce dose to 1g OD
d) Increase dose to 1.5g BD
Question 9
Your SHO asks you to prescribe gentamicin for a
50year male patient with suspected urosepsis?
Seen on A+E. What information do you need?
1. Weight
2. Renal function
3. Previous A+E documention
4. All of above
Question 10
Your patient has been diagnosed with severe
Hospital Acquired Pneumonia. Has been started on
co-amoxiclav IV 1.2g TDS. History of CDT. What
do you do?
a) Speak to microbiologist regarding management
b) Add in metronidazole
c) Continue with co-amoxiclav
d) All of above
Audit
Data on compliance with the antibiotic
formulary done quarterly.
If interested in participating in an audit
contact antimicrobial
pharmacist/microbiologist
WHO definition - HAI
Patient admitted for reason other than Infection
Infection was not present or incubating at admission
Develops over 48 hours after admission
Develops post discharge
Also includes occupational infections in HCW
Screening
MRSA (Limited)
CPC (All those admitted to other hospital in
last 12m)
VRE (Known positives and those admitted
from units with high prevalence
SisterStaff nurse
Student nurseConsultant
Senior doctorJunior doctor
HCAAllied
Porter
0
100
200
300
400
500
600
700
Total Opportunites, Hand Hygiene Events, and Percent
Opportunities
Hygiene
Percent
HAND HYGIENE
We do not wash our hands as often we think
we do
Single most important thing you can do to
prevent the spread of infection.
Hand hygiene SAVES LIVES.
Single most effective intervention during XDR
bacterial outbreaks.