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Antibiotics

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Prophylactic antibiotics prevent serious infection in specific situations (e.g. ... Azithromycin 500mg iv gentamicin 4-6g daily Benzylpenicillin 1.2g q6h. severe ... – PowerPoint PPT presentation

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Title: Antibiotics


1
Antibiotics
  • Judith Coombes, University of Queensland

2
General Principles
  • Establish the need for antibiotic therapy
  • When not to prescribe
  • Viral or minor bacterial disease
  • Viral diarrhoea
  • Sore throat
  • Sinusitis
  • Common cold
  • Are self limiting
  • Common cold needs common sense campaign

3
Antibiotic treatment can be
  • Prophylactic antibiotics prevent serious
    infection in specific situations (e.g. preventing
    the spread of meningococcal disease).
  • Presumptive antibiotic therapy is indicated in
    some circumstances (e.g. a human bite to the hand
  • Use empirical antibiotic therapy which is aimed
    at the likely causative organism to manage an
    infection until microbiological culture and
    susceptibility results are known
  • When the cause of an infection is confirmed,
    directed therapy is aimed at the specific
    pathogen.

4
MIND ME
  • M microbiology guides therapy wherever possible
  • I indications should be evidence-based
  • N narrowest spectrum required
  • D dosage appropriate to the site and type of
    infection
  • M minimise duration of therapy
  • E ensure monotherapy in most situations

5
5 Antibiotics
  • Benzylpenicillin or Amoxycillin
  • Streptococcis
  • Cloxacillin
  • Staphylococcis
  • Vancomycin
  • MRSA
  • Gentamicin
  • Pseudomonas
  • Metronidazole
  • anaerobes

6
Skin and Soft Tissue
7
UTI
8
Cardiovascular
9
Respiratory
10
CNS
11
Sepsis- definition
  • In adults and older children, severe sepsis is
    the systemic response to an infection manifested
    by organ dysfunction, hypoperfusion or
    hypotension combined with 2 or more of the
    following
  • fever,
  • tachycardia,
  • tachypnoea,
  • elevated white cell count

12
Sepsis
13
Gentamicin Revision
  • Gram negative bactericidal agent
  • Excellent anti-pseudomonal cover
  • Once daily dosing benefits vs tds or bd
  • high peak level excellent distribution
  • post antibiotic effect (gt24-36 hours)
  • reduced monitoring and administration
  • reduced nephro and ototoxicity
  • easier monitoring (10-12 hours post dose)

14
Severe risks of nephrotoxicity and ototoxicity
  • Mrs HR
  • 78 years, wt 57kg
  • Admitted to outlying hospital acute exacerbation
    COPD
  • Baseline Cr 80?mol/L, Urea 8.5
  • Charted gentamicin 160mg daily for 5/7 no
    levels requested
  • Baseline CrCl 45ml/min

15
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16
Patient progress
  • 15/6 K 6.7, Acidotic to ICU haemodialysis
  • 21/6 Gent level still 1.4!!!!
  • 23/6 complaining of dizziness, unsteady feeling,
    vestibular symptoms, vomiting
  • 1/7 Cr 0.21 recovering
  • 14/11 Out patient permanent Ototoxicity

17
Local Sri Lankan Hospital
  • 75 yr old patient post amputation, septic
  • Gentamicin iv 80mg tds, Co Amoxyclav iv
    metronidazole iv
  • Day 7 reviewed by anesthetists pain control
  • Noted Urea increased from 7.1 15.2
  • Patient not septic - ? Need for antibiotic
  • Seen Day 12 post operative, Urea 26 same dose
    gentamicin

18
Aminoglycoside dosing and Monitoring
  • Case continued
  • Day 3
  • Mr AD (67yrs) has now developed sever hospital
    acquired pneumonia
  • Ward round decisions
  • start gentamicin once a day
  • dose as per levels each night at 2000
  • recall patient weighs 70 kg
  • creatinine has improved (now 140 micro mole/l)
  • start Co-Amoxiclav 1.2g IV q8h

19
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20
Creatinine Clearance
  • Recall Cockcroft-Gault Formula
  • CrCl (mL/min) 140-age (years) ideal weight
    (kg)
  • 0.814 serum creatinine (micromol/L)
  • ? 0.85
  • If patient 70 kg, 67 y.o. with serum
    creat140micromol/L
  • CrCl 42 mL/min (140-67 X 70) / (0.814 x 140)

21
Calculating first dose gent
22
Gentamicin Dose Adjustment
  • Day 4
  • gentamicin level 2.5
  • (taken 0800, 12 hrs post dose)
  • The initial dose given in emergency department
    was 280mg (4mg/kg x approx 70kg)
  • Prescribe new gentamicin dose based on level

23
2.5
24
Gentamicin Dose Adjustment
  • Level at 12 hours 2.5 (ideal lt 2)
  • New Dose Level Wanted (mg/L) x Dose Given (mg)
  • Level Achieved (mg/L)
  • In this case (1.5/2.5) x 280 168 mg
  • round down to 160 (nearest multiple of 40 mg)
  • amps 40 mg/mL

25
Adjusting doses of gentamicin
26
When NOT to take levels
  • Do not take levels if
  • Stat dose
  • Or
  • Patient has Normal renal function and is only
    receiving 1 or 2 doses ie prophylactic

27
Variable Dose Medication
Drug Level and Time Taken
Dose Time and Actual Time Given
28
Use in moderate to severe renal function
  • Where ever possible withhold other nephrotoxic
    drugs and ensure no other altenative
  • Ie unavoidable use of gentamicin
  • Requires extended dose intervals 36, 48 or 96
    hours
  • Effectively daily levels wait til lt 1.0mmol/l
    then dose again

29
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