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1. Is an antibiotic indicated?
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2. Cultures before administering AB in hospitalised patients or patients with recurrent infections
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3. Choose an appropriate empiric antibiotic
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4. Correct dose and route of administration
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5. Start AB rapidly in severe infections
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6. Practice early and effective source control
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7. Evaluate appropriateness everyday
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Depend on diagnosis?
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> Fever
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> Leukocytosis
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> Raised inflammatory markers
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> Specific organ dysfunction
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Haematology
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||
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White Cell count
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4-11/L
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+
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Erythrocyte sedimentation rate
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0-22mm/hr (men)
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+
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0-29mm/hr (women)
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Platelets
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140-440/L
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-
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C-reactive protein
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0-10
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+
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Infective endocarditis (patients with prosthetic heart valves/valvular disease)
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> Dental, oral or URT procedures
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> GU surgery / GI procedures
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Rheumatic fever (reoccurrence)
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Meningococcal disease (contacts)
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Surgical
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TB (high risk individuals / contacts)
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HIV (high risk individuals / contacts)
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Choose by assessing:
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1. Source of infection:
Community acquired Before or less than 48 hours of admission to hospital. Microorganism expected? Wild/non-resistant mo's. 1st line antibiotics. Less side effects.
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Hospital acquired >48 hours after admission or within 30 days of discharge. Microorganisms expected? Mutated / resistant microorganisms. Second line antibiotics. More side-effects.
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Recurrent
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2. Site of infection:
Peripheral line sepsis=skin/soft tissue. Likely pathogen. Staph. aureus. Coagulase negative staphylococci, strep. spp.
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Bacterial infection of bone due to contaguous spread from soft tissues, haematogenous seeding or direct inoculation.
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Common aetiologies
– S aureus. – Coagulase--‐negative staphylococc
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Occasional
– Streptococci. - Enterococci. - Gram--‐negative bacilli.
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Other
– M tuberculosis. – Fungal infections.
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.png)
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Most likely pathogen for site of infection
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> Gram + cocci:
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Skin
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> Gram - bacilli:
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Urethras
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> Gram + and -, anareobes:
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Large intestine
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Microbial culture and sensitivity results done.
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Growing microbe to identify the type of bacteria.
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Rationalise if an antibiotic is indicated?
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What pharmacological / non-pharmacological treatment would you recommend?
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How would you monitor the efficacy and safety of the treatment once initiated?
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What is a possible complication of a sore throat? - Otitis media (spread of infection to the middle ear) Meningitis (spread of infection to the lining of brain and spinal canal) Pneumonia (lung infection)
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