Antibiotic Selection and Use Principles

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Questions and Answers

What should be considered when selecting an antimicrobial regimen for a patient?

Drug specific, patient specific, spectrum of activity, dosing, pharmacokinetic properties, pharmacodynamic properties, adverse effect potential, drug-interaction potential, cost, anatomic location of infection, antimicrobial history, drug allergy history, renal and hepatic function/age, concomitant medications, pregnancy or lactation, and compliance potential.

What is the primary goal of patient education in antimicrobial therapy?

To educate the patient on the proper use of antibiotics, potential side effects, and the importance of compliance.

What is de-escalation of antimicrobial therapy based on culture results?

Discontinuation of antibiotics that are providing a spectrum of activity greater than necessary to treat the infection.

What is monitoring in the context of antimicrobial therapy?

Monitoring for clinical response, adverse effects, efficacy, toxicity, and laboratory data. Signup and view all the answers

What is a common cause of failure of antimicrobial therapy?

Inadequate diagnosis resulting in poor initial antimicrobial or other non-antibiotic drug selection. Signup and view all the answers

What should be reevaluated in cases of antimicrobial therapy failure?

Antimicrobial therapy, source control, and alternative non-infectious diagnoses. Signup and view all the answers

Why is it important to perform source control in antimicrobial therapy?

To remove the source of infection and prevent further infection. Signup and view all the answers

What is the purpose of switching from IV to oral antibiotics?

To reduce cost and promote patient convenience. Signup and view all the answers

Why is correct selection, use, and monitoring of clinical response of antibiotics important?

To cure the patient's infection, limit harm by minimizing patient risk for adverse effects, and limit societal risk from antimicrobial-resistant bacteria. Signup and view all the answers

What are the two types of infections?

Nosocomial and community-acquired infections. Signup and view all the answers

What is the difference between virulence and resistance?

Virulence refers to the ability of a microorganism to cause disease, while resistance refers to the ability of a microorganism to survive in the presence of an antibiotic. Signup and view all the answers

What is the purpose of obtaining bacterial cultures prior to initiating antimicrobial therapy?

To identify the causative microorganism and determine its susceptibility to antibiotics. Signup and view all the answers

What is fever, and what are some other causes of fever besides infection?

Fever is a rise in temperature arising as part of the overall host response to microbial toxins. Other causes of fever include medications, trauma, and other medical conditions such as autoimmune disease, malignancy, pulmonary embolism, and hyperthyroidism. Signup and view all the answers

What are some circumstances where patients with infections may not present with fever?

Elderly patients, patients with overwhelming infection, or patients with localized infections such as UTIs. Signup and view all the answers

What are the goals of antimicrobial therapy?

To cure the patient's infection, limit harm by minimizing patient risk for adverse effects, and limit societal risk from antimicrobial-resistant bacteria. Signup and view all the answers

What are endogenous infections?

Infections that arise from an alteration in one's own normal flora. Signup and view all the answers

Study Notes

Importance of Antibiotic Selection

Correct selection, use, and monitoring of antibiotics is crucial to ensure proper treatment of infections, prevent harm, and minimize the risk of antimicrobial resistance.

Guiding Principles

Make an accurate diagnosis
Minimize harm to the patient and prevent adverse effects, including secondary infections
Limit the risk of antimicrobial-resistant bacteria in the community

Goals of Antimicrobial Therapy

Cure the patient's infection
Minimize harm to the patient by limiting adverse effects, including secondary infections
Limit the risk of antimicrobial-resistant bacteria in the community

Etiology of Infections

Nosocomial infections: acquired in a healthcare setting
Community-acquired infections: acquired outside of a healthcare setting

Pathophysiology

Endogenous infections: arise from an alteration in one's normal flora
Exogenous infections: acquired from an external source, such as human-to-human transmission or contact with environmental bacteria

Virulence vs. Resistance

Virulence: the ability of an organism to cause disease
Resistance: the ability of an organism to withstand the effects of antibiotics

Clinical Presentation and Diagnosis

Physical examination: fever, physical signs, and symptoms
Imaging studies: radiographs, CT, MRI to determine anatomic localization of infection
Non-microbiologic laboratory studies: WBC, ESR, CRP
Microbiologic studies: culture, direct examination of specimen (e.g., sputum, blood, urine)

Clinical Presentation of Fever

Fever: a rise in temperature due to the host response to microbial toxins
Non-infectious causes of fever: medications, trauma, autoimmune disease, malignancy, pulmonary embolism, and hyperthyroidism
Some patients may present with hypothermia or be afebrile, especially elderly patients or those with localized infections

Treatment

Considerations for selecting antimicrobial regimens:
- Drug-specific factors (spectrum of activity, dosing, pharmacokinetic and pharmacodynamic properties, adverse effect potential, drug-interaction potential, cost)
- Patient-specific factors (anatomic location of infection, antimicrobial history, drug allergy history, renal and hepatic function, age, concomitant medications, pregnancy or lactation, compliance potential)

Outcome Evaluation

Patient education: importance of adherence to treatment, monitoring for adverse effects, and reporting of symptoms
De-escalation of antimicrobial therapy based on culture results
Discontinuation of duplicative spectrum antibiotics
Switching to a narrower spectrum antibiotic once clinically stable
Switch from IV to oral antibiotics when possible

Monitoring

Monitor for clinical response, adverse effects, and imaging results
Evaluate efficacy through vital signs, clinical findings, and physical exam findings
Monitor for toxicity through adverse effects and laboratory data

Failure of Antimicrobial Therapy

Causes:
- Inadequate diagnosis resulting in poor initial antimicrobial selection
- Poor source control
- Development of a new infection with a resistant organism
- Alternative non-infectious diagnosis
- Re-evaluation for sources of untreated infection
- Consideration of drug- and patient-specific factors

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Description

Learn about the importance of correct antibiotic selection, use, and monitoring to ensure proper treatment of infections and minimize antimicrobial resistance.