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Practical Antibiotic Prescribing & Antibiotic Awareness. Berny Baretto (Antibiotic Pharmacist) 21st November 2013. Contents. Antibiotic Awareness Day-18 th November 2013 How to prescribe an antibiotic Why is it important? Background Audit

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practical antibiotic prescribing antibiotic awareness

Practical Antibiotic Prescribing & Antibiotic Awareness

Berny Baretto (Antibiotic Pharmacist)

21st November 2013

contents
Contents
  • Antibiotic Awareness Day-18th November 2013
  • How to prescribe an antibiotic
  • Why is it important?
  • Background
  • Audit
  • What must be included in an antibiotic prescription
  • Practical examples
  • Gentamicin Prescribing
  • Summary
european antibiotic awareness day campaign to promote prudent antibiotic use supported by doh
European Antibiotic Awareness Day- campaign to promote prudent antibiotic use(supported by DOH)
key messages
Key Messages
  • It is a public health initiative aimed at encouraging responsible use of antibiotics
  • Lack of new antibiotics being developed especially to cover gram negative bacteria.
  • Number of infections due to antibiotic–resistant bacteria is growing
  • Important to preserve the use of the antibiotics currently available eg carbapenems
background contd use selects resistance
Background contd-Use selects Resistance
  • Acquired resistance absent from bacteria collected pre-1940
  • Resistance repeatedly followed introduction of new antibiotics
  • Resistance greatest where use heaviest
  • Resistant mutants selected in therapy
lactam use resistance in s pneumoniae
Β-Lactam use & resistance in S.pneumoniae

Low rates of antibiotic use = low resistance

Bronzwaer et al Emerg Infect Dis. 2002; 8:278-82

how to prescribe an antibiotic why is it important
How to prescribe an antibiotic –why is it important
  • Department of Health Guidelines-(Advisory Committee on antimicrobial resistance and healthcare associated Infection)-Nov 2011
  • Antimicrobial stewardship- “start smart-then focus”-
  • Want :
  • Right Drug
  • Right Dose
  • Right Time
  • Right Duration
  • For Every Patient
start smart is
Start Smart Is :
  • Don’t start antibiotics in the absence of clinical evidence of bacterial infection
  • If there is evidence or suspicion of bacterial infection-use local antibiotic guidelines to start treatment
  • Document on drug chart Indication, duration/review date, route & dose
  • Obtain cultures first
  • Prescribe single dose antibiotics for surgical prophylaxis-where proven efficacy
then focus is
Then Focus is:
  • Review clinical diagnosis and the coninuing need for antibiotics by 48 hours and make a clear plan of action- “the antimicrobial prescribing decision”
  • 5 options
  • 1. STOP
  • 2. Switch i/v to oral
  • 3. Change –ideally to narrower spectrum or broad if needed
  • 4. Continue (review again at 72 hours)
  • 5. Outpatient Parenteral antibiotics therapy (OPAT)
  • Make sure review and decision is clearly documented in medical notes.
good prescribing practice
Good Prescribing Practice
  • Promotes Good Prescribing Practice- no missed doses, ensures continuity in care
  • Adherence to Trust Antibiotic Policy
  • Helps to Reduce Incidence of Clostridium difficile Infection
  • Audit
what must be included in an antibiotic prescription documentation of allergy status
What must be included in an antibiotic prescription-Documentation of allergy status
gentamicin prescribing
Gentamicin Prescribing
  • 5 steps for safe gentamicin prescribing
  • Usually gentamicin is only required for 24-48hrs.
  • Course lengths for gentamicin should not exceed 5 days unless Microbiology have approved its use for extended durations (this may be indicated in some infections eg Endocarditis).
1 weigh patient
1. Weigh Patient:
  • Weigh patient. If weighing is not possible, estimate weight using ideal body weight formulae (based on height and gender).
  • For obese patients >120% ideal body weight use formula for dosing weight.-see below.
equations for ideal body weight and obese dosing
Equations for Ideal Body weight and Obese dosing
  • Imperial
  • Ideal Body weight (Male) = 50 + (2.3 x inches over 5 feet)
  • Ideal Body weight (Female) = 45.5 + (2.3 x inches over 5 feet)
  • Or
  • Metric
  • Ideal Body weight (Male) = 50kg + 0.9kg for each cm above 150cm in height
  • Ideal Body weight (Female) = 45.5Kg + 0.9kg for each cm above 150cm in height
  • For Obese Patients (> 120% of ideal body weight) use obese dosing weight calculation5 :
  • Obese Dosing Weight (in Kg) = ideal body weight + 0.4 (actual Body weight – ideal body weight)
2 calculate gentamicin dose
2. Calculate gentamicin Dose :
  • Calculate the gentamicin dose using 5mg/Kg (maximum 400mg od)
  • a)If normal body weight - use actual body weight value
  • b)If Obese (> 120% of ideal body weight)- use obese dosing weight
  • c) if weight unobtainable – calculate ideal body weight
3 calculate creatinine clearance crcl
3. Calculate creatinine clearance (CrCl) :
  • Calculate the creatinine clearance using Cockcroft and Gault equation
  • Creatinine = (140-age in years) x weight in Kg(from step 1) x F
  • clearance Serum Creatinine (in micromole/Litre)
  • F=1.04 (female) or F=1.23 (male)
4 check dosing interval and when levels need to be done
4. Check dosing Interval and when levels need to be done :

Work out the dosing interval and when levels should be checked

5 check gentamicin serum level
5. Check gentamicin serum level
  • If pre-dose gentamicin level is 1mg/L or less continue the original dosing regime
  • If pre-dose gentamicin level is greater than 1mg/L, consult Microbiology or Pharmacy for advice.
summary
SUMMARY
  • 1. Antibiotic Awareness
  • 2. What to include when prescribing an antibiotic-practical examples
  • 3. Why do we document this- The background
  • 4. Audit
  • 5. Gentamicin prescribing