抗生素管理工作(英文PPT)Antibiotic Stewardship
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• If antibiotics started and continued, 5 days should suffice
CoNS bacteremia
• How do you know if it’s real or contamination?
• When the diagnosis is uncertain, antibiotics are often prescribed…
– Stewardship strives to fine tune antibiotic Rx in regards to
• Efficacy • Toxicity • Resistance-induction • C. difficile-induction • Cost • Discontinuation
Viralຫໍສະໝຸດ BaiduURI
• How do you know it’s viral and not bacterial?
Exacerbation of COPD
• How do you know if it’s bacterial?
– ……..
• Antibiotics not unreasonable.
Antibiotic Stewardship
C.G. Wlodaver, M.D.
What is Antibiotic Stewardship?
• A program that encourages judicious (vs injudicious) use of antibiotics
– Antibiotics are relatively so effective, non-toxic and inexpensive…so easy to use…that they are prone to abuse
• Redundancy
– E.g. Unasyn or Zosyn + Flagyl…
When to discontinue antibiotics altogether!
• Asymtomatic UTI • Viral URI • Exacerbation of COPD??? • CHF misdiagnosed as pneumonia • CoNS bacteremia, when contamination
• Allergy • Efficacy
– Empiric, vs MRSA – Based on culture and sensitivity
• Dosing
– Cefazolin, q8h – Ceftriaxone, q24h – Levels
• Vancomycin… • Aminoglycosides…
How does it relate to MRSA?
• Resistance-induction: MRSA and other MDRSs
– Darwinism
• Flemming • Weinstein, L • Native American wisdom
• Efficacy
– Some prescribers are still in the MSSA era
Does it work?
• Data…………….
Recommended by
• Collaborative
– Drs. Perl, Bratzler, CW
• IDSA • Practiced regularly
How does it work?
• A pharmacist, par excellence, or someone else… reviews patients on antibiotics and makes recommendations, prn; overseen by ID-trained physician, when available.
– Training…
• Physician contacted
– Telephone call… – Notation in chart…
• Rx change written
– Pharmacist, verbal order – Physician
Common Interventions
Some are so evident that they should be automatic
more likely than true infection • Duration: criteria to d/c
Asymtomatic UTI
• Definition: pyuria/bacteriuria, without Sx, e.g. temperature and WBC WNL
• Common • Data…………
– 5 days should suffice…
CHF misdiagnosed as pneumonia
• How do you distinguish one from the other?
– H&P, temperature, WBC, CXR, BNP, cultures (sputum and blood), pneumococcal urine antigen……
What are its limitations?
• It’s difficult/dangerous… to practice clinical infectious diseases with limited information
– Select cases very carefully – Primum non nocere
• IV-to-po switch
– Criteria
• Afebrile • WBC normalized • Oral bio-availability, e.g. quinolones………. • Intact GI tract
– Patient can often go home on po without further in-hospital observation……..
CoNS bacteremia
• How do you know if it’s real or contamination?
• When the diagnosis is uncertain, antibiotics are often prescribed…
– Stewardship strives to fine tune antibiotic Rx in regards to
• Efficacy • Toxicity • Resistance-induction • C. difficile-induction • Cost • Discontinuation
Viralຫໍສະໝຸດ BaiduURI
• How do you know it’s viral and not bacterial?
Exacerbation of COPD
• How do you know if it’s bacterial?
– ……..
• Antibiotics not unreasonable.
Antibiotic Stewardship
C.G. Wlodaver, M.D.
What is Antibiotic Stewardship?
• A program that encourages judicious (vs injudicious) use of antibiotics
– Antibiotics are relatively so effective, non-toxic and inexpensive…so easy to use…that they are prone to abuse
• Redundancy
– E.g. Unasyn or Zosyn + Flagyl…
When to discontinue antibiotics altogether!
• Asymtomatic UTI • Viral URI • Exacerbation of COPD??? • CHF misdiagnosed as pneumonia • CoNS bacteremia, when contamination
• Allergy • Efficacy
– Empiric, vs MRSA – Based on culture and sensitivity
• Dosing
– Cefazolin, q8h – Ceftriaxone, q24h – Levels
• Vancomycin… • Aminoglycosides…
How does it relate to MRSA?
• Resistance-induction: MRSA and other MDRSs
– Darwinism
• Flemming • Weinstein, L • Native American wisdom
• Efficacy
– Some prescribers are still in the MSSA era
Does it work?
• Data…………….
Recommended by
• Collaborative
– Drs. Perl, Bratzler, CW
• IDSA • Practiced regularly
How does it work?
• A pharmacist, par excellence, or someone else… reviews patients on antibiotics and makes recommendations, prn; overseen by ID-trained physician, when available.
– Training…
• Physician contacted
– Telephone call… – Notation in chart…
• Rx change written
– Pharmacist, verbal order – Physician
Common Interventions
Some are so evident that they should be automatic
more likely than true infection • Duration: criteria to d/c
Asymtomatic UTI
• Definition: pyuria/bacteriuria, without Sx, e.g. temperature and WBC WNL
• Common • Data…………
– 5 days should suffice…
CHF misdiagnosed as pneumonia
• How do you distinguish one from the other?
– H&P, temperature, WBC, CXR, BNP, cultures (sputum and blood), pneumococcal urine antigen……
What are its limitations?
• It’s difficult/dangerous… to practice clinical infectious diseases with limited information
– Select cases very carefully – Primum non nocere
• IV-to-po switch
– Criteria
• Afebrile • WBC normalized • Oral bio-availability, e.g. quinolones………. • Intact GI tract
– Patient can often go home on po without further in-hospital observation……..