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IOS 10 Exam 3
Basic principles of Antibiotic use
| Question | Answer |
|---|---|
| Increase in neutrophils indicates either | Bacterial or fungi infection |
| Lymppcyte elevation indicates a | Viral infection |
| Monocyte elevation can indicate | Infection with Listeria monocytogenes or M. tuberulosis |
| Eosinohil elevation can indicate | Allergic reaction, or parasitic infection |
| Basophil elevation can indicate an | Allergic response |
| Left shift is a | Increase in neutrophils,and bands and lympocytes, and monocytes |
| Factors involved in determining the most likely organism | Site of infection, method of acqusition(hospital or community) Patient specific information (Age, Immune status, underlying illiness, previous antimicrobial therapy, & previous Ab therapy-dose,duration) |
| Patient factors influencing potiential pathogens | Age, pre-existing disease, other conditions (indwelling catheter, steroid therapy, surgery of urinary tract) |
| Goals of antibiotic therapy | Cure the infection (most eradication), supportive care, prevention of infection |
| Best antibiotic rules of thumb | activity & efficacy against suspected or known pathogen- narrow efficacy, bactericidal, low resistance |
| 11 Steps of antimicrobial therapy | 1.Is Antibiotic indicated 2.Clinical specimens 3.Organism 4.Goals of therapy 5. Best antibiotic 6.Combo therapy 7.Route of administration 8. Appropriate dose 9. Duration of therapy 10. Monitor 11.Reason of clinical failure |
| Best antibiotic determined by | Age, allergies, prior ABX, immunosuppression, prostetic devices, concurrent disease states, renal and hepatic function, site and severity of infection, penetration to site of infection, routes of administration, compliance issues |
| Pregnancy and lactation recommendation | PCN, cephs, erythro base, azetronam, Caution: AG, vanco, clinda, imipenem/cilastatin, TMP |
| Best Antibiotic characteristics | PK, SE, compliance, Cost |
| Emergence of drug resistance | SPACE M Serratia Psedomonas, acinetobacter, Cintrobacter, Enterobacter, mycobacerium tuberculosis- used combination therapy |
| Critically ill alterations are | Immunologic failure, respiratory failure, renal failure, endothelial failure, endocrine dysfunction, neuromuscular dysfunction, cardiovascular failure, CNS dysfunction, Hepatic dysfunction, GR failure- these all effect antibiotic selection |
| Needs for combination therapy | Mixed infection, or need for synergy against P. aeruginson, wnterococcus, or staphylococci |
| Route of Administration | Mild infection-topical or oral Moderately severe infection- oral or IV/IM Severe infection IV therapy |
| Duration of therapy | Poorly defined in ID, dependant of organism, location, host, response to therapy, AB selection, and comfort level |
| Disadvantages of Combo therapy | Increased: resistance, risk of superinfection, toxcities, potential for drug interactions, increase in cost |
| Appropriate dose therapy | Lozest dose of antibiotic that will provide desired effect via PK/PD, aggressive dosing required in many clinical situations |
| Efficacy parameters | WBC with diff= Absolute WBC increase, increase in bands and segs, gram stain and culture results |
| Monitoring parameters | VS, temperature, Bp, erythema, swelling, discharge, myalgia, arthralgia, heart and respiratory rates, history of illiness |
| Other efficacy parameters | Chest radiograph, CT scan, MRI, erythrocyte sedimentation rate, C-reactive protein, PTL, Group A test, seriologic antibody test-HIV chlamydia |
| Monitoring paramaters for safety of therapy | Subjective reports/complaints, PE, Labs, drug toxicities, drug interactions, compliance issues |
Created by:
liza001
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