Antibiotics update

74 Pages·2012·3.11 MB·English

AAnnttiibbiioottiiccss UUppddaattee 
Dr Kieran Hand 
CConsulltant PPhharmaciist ‐ AAntii‐IInffectiives 
University Hospital Southampton
NHS Foundation Trust
38th UK Medicines Information
Practice Developpment Seminar
University of Warwick, 13th – 14th September 
2012
AA ggaammee ooff ttwwoo hhaallvveess
• First half • Second half
– An interesting anecdote – Ask the audience
Prize-winning schoolgirls take quantum leap from babies’
bottoms to dairy cows’ udders
By Jimmy Woulfe, Mid-West Correspondent
Thursday, May 03, 2012
Two Co Limerick schoolggirls have found a widelyy-used cream for soothingg
babies’ bottoms is a great remedy for dairy cows with sore udders caused
by mastitis.
Both girls did their research on the family farms run by their dads. They
ffoundd tthhatt a ttubb off SSuddocrem costtiing €€44 can cllear masttiittiis iin a ddaiiry cow
just as quickly as widely-used veterinary injections which cost €60 per
treatment.
Evaluating appropriateness: what factors influence 
choice / dose / route / duration of therapy?
•• PPrreesseennttiinngg ccoommppllaaiinntt // ssiiggnnss &&  •• PPrreevviioouuss aannttiibbiioottiiccss
symptoms
• Biochemistry / haematology results / 
• Evidence of infection (+SIRS) urine dipstick
• PPaasstt mmeeddiiccaall hhiissttoorryy ((ee..gg.. pprroosstthheettiicc  • AAlllleerrggyy // iinnttoolleerraannccee
valve, epilepsy)
• Pregnancy / breastfeeding
• Immune status/immunosuppressants
• Organ dysfunction
• Family / social contacts
• GI absorpption // swallowingg
• Occupation / hobbies
• Expert advice
• Travel history
• Source control
• Pets / animal contact
• Local pathogen epidemiology and 
• DIAGNOSIS and likely pathogens resistance
• Severity of infection • Antibiotic spectrum
• Prescriber’s training / experience • Site of infection (penetration)
• PPeer addviice // consullttantt prefference • DDosiing regiimen ((PPKK//PPDD))
• Local guidelines / policy • Interacting drugs (e.g. iron and 
doxycycline)
• Recent contact with healthcare
• EEtthhnniicciittyy ((ee.gg. GG66PPDD ddeeffiicciieennccyy)).
•• RReecceenntt oorr pprreevviioouuss mmiiccrroobbiioollooggyy // 
serology investigations.
Skin & soft tissue infections: 
iinn vviittrroo sseennssiittiivviittiieess ffrroomm SSoouutthhaammppttoonn 
GPs 11/12
100
90
80
Penicillin
70
e
Flucloxacillin
v
i 6600
tt
i Erythromycin
s
n 50
e Doxycycline
s
40

%% RRiiffaammppiicciinn
30
Fusidic acid
20
Ciprofloxacin
1100
0
Staph aureus
Southampton GP isolates 2011/12
TTaakkee aa cchhaannccee oonn mmee
• Trust me I’m a doctor
• I have a remarkable 
memory for facts
• II’mm ggooiinngg ttoo ssttaarrtt yyoouu 
on ‘Cefanmet’
•• MMyy rraabbbbiitt’ss ffoooott hhaass 
never failed me
Ebbinghaus’ forgetting curve 
(try to remember it)
Which of these two men would you 
send to the supermarket?
TThheerree iiss aannootthheerr wwaayy…
• Bear with me while I 
consult our treatment 
guidelines
• Hmm, they don’t seem 
to cover your particular 
circumstances
• I think I will get some 
exppert advice
Hospital pharmacist knowledge of 
antiibbiiotiics andd iinffectiion
Assessment results by subject area (ITT)
100
75
Baseline (all)
% 50
FFiinnaall ((aallll))
25
0
hogenPath miologyepidem Diagnosis/monitoring Choice of antibioticn minationElim eatmentEmpirical tre ractionsInter of actionMechanism o inf manPrinciples of -effectsSide Antibiotic spectrump
Hand K & Jubraj J 2005 (MSc)