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Antimicrobe Regimen

Antimicrobial Regimen Selection

QuestionAnswer
How do antimicrobials differ from other drug classes in terms of their effects on individual patients as well as on society as a whole? Antimicrobials perform their actions on the organism targeted rather than on the host itself.
Bactericidal Kills 99.9% (3-log) of a bacterial population.
Bacteriostatic Kills less than a bactericidal agent does.
Post-antibiotic effect (PAE)
Normal flora Bacteria/organisms normally found on/in a particular anatomic location of a patient.
Pathogen Disease-causing organism.
Empiric therapy General, broad-spectrum therapy used before culture/sensitivity is known. Best-educated guess based on patient- and antimicrobial-specific factors.
Prophylactic therapy Therapy given/administered in order to prevent future infections.
Synergy Effects of a drug are greater when used concomitantly with another therapy.
Narrow-spectrum activity An antimicrobial that kills a few specific species of bacteria.
Broad-spectrum activity An antimicrobial that kills several different species of bacteria. Often chosen as empiric therapy.
Expected normal flora for skin Staph. aureus Staph. epidermidis micrococci diphtheroids
Expected normal flora for GI tract lactobacillus Strep. sp. enterococcus enterobacteriacae diphtheroids few anaerobes peptostreptococcus bacteroides sp. Clostridium sp. Pseudomonas sp.
Expected normal flora for mouth oral anaerobes Vridans streptococci
Gram stain Gram(-) vs. Gram(+) shape of organism presence of WBCs
Culture Information on specific organism Antimicrobial susceptibility (S,I,R)
CBC complete blood count
Left shift An increased rate of release of neutrophils into blood/tissues in response to infection.
MIC Minimum Inhibitory Concentration The lowest concentration of antimicrobial that inhibits visible bacterial growth. Helps to determine level of susceptibility.
Time-dependent kill/Time above the MIC Antimicrobial activity based on time above MIC rather than on an increased dose.
Concentration-dependent kill Antimicrobial activity based on amount of dose rather than on time above the MIC.
B-lactamase antibiotic selection Concentration-independent/Time-dependent Choose dose to maintain blood/tissue concentrations above the MIC in a time-dependent manner.
Drug-specific considerations in antimicrobial selection Spectrum of activity Effects on nontargeted microbial flora Appropriate dose Pharmacokinetic properties Pharmacodynamic properties Adverse drug reactions (ADRs) Drug interactions Cose
Patient-specific considerations in antimicrobial selection Recent previous antimicrobial exposures ID of anatomic location of infx Hx of drug allergies Organ dysfunction (may affect clearance) Immunosuppression Pregnancy Compliance
De-escalation From a broad-spectrum empiric therapy to a narrow-spectrum antimicrobial.
Common causes of antimicrobial failure Inadequate Dx Poor initial antimicrobial selection Poor source control Development of a new infx w/resistant organism Non-adherence Insufficient dosing Drug interactions Development of secondary infx/suprainfx
Created by: Carrie D.
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