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Transcript of Antimicrobial Stewardship
Interpret the clinical signs of infection
Construct a reasoned argument to altering antimicrobial therapy Oral switch considerations:
Patient able to swallow and absorb
Suitable oral option
Bioavailability of oral option Mr Roland Smith DOB 24/11/68
Microbiology report 10/05/12
Sample: blood culture
Isolated: Pseudomonas aeruginosa (Ps)
Colistin R The right drug for the bug at the correct dose, by the correct route for the correct duration Case Studies John Warburton Review at 48 hours Signs of infection Case 2 "...then focus"
A 73 year old lady was admitted with acute confusion, a fever and discomfort on passing urine. Is the prescription appropriate? What else do you need to know? Day 3 -Antibiotic prescription "Start smart - then focus" Department of Health campaign Only start if signs of infection
Send cultures first
Use local antibiotic guidelines
Documented review/stop date High temp,
raised WBC (neutrophilia, lymphopenia),
low blood pressure,
confusion, local signs e.g. skin redness,
raised CRP Stop
Continue Case 1 "Start smart..."
A 66 year old man admitted with a severe cough which could be pneumonia, the doctors want you to recommend an antibiotic. What should you recommend and what must be clear from the prescription? What else do you need to know? In pairs construct a reasoned argument for persuading the doctor to amend the prescription based on what you have learnt. Amoxicillin 1 gram IV 24/3/12 26/3/12 14:00 SB/HG SB/HG SB/HG JW/HS JW/HS JW/HS 24/3 25 26 27 NB/LT NB/LT JW/LT NB/LT Bob UTI