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Micro - Intro to Antibiotics + their Classification (iii) (Start smart…
Micro - Intro to Antibiotics + their Classification (iii)
metronidazole
anti-anaerobic
good for intra-ab infections (bacteroides, fusobacterium, clostridium)
anti-protozoal
used in combination tx for bowel surgery prophylaxis
inactive against staph + aerobic gram -ve bacilli (E Coli)
the ideal anti infective
selectively toxic (to pathogen + not host cells)
favourable pharmacokinetics (good bioavailability - lots reaches target tissue)
not many SEs
can withstand bacterial resistance mechanisms
Therapeutic index = ED50 - TD50
Start smart then focus
only start antibiotic if there is evidence of clinical infection
obtain appropriate cultures (prevents false -ves)
specify route, indication + duration on prescription
give drug within 4 hrs of prescription or 1hr of sepsis Dx
choose appropriate drug based on...
suspected pathogen
common causes
local epidemiology (+ local patterns of resistance)
hosp vs community-acquired
acquired outside Ire (travel Hx NB)
host factors
allergy
site
severity
previous antibiotics taken
knowledge of antibiotics (spectrum, bactericidal vs bacteriostatic)
1-2 days after starting antibiotic make an antimicrobial prescribing decision
review clinical Dx with lab/radiology results
stop or switch to oral from IV or narrow drug or continue or discharge with outpatient parenteral antibiotic Tx (OPAT - decreases length of hosp stay)