Last Updated on January 24, 2019 by FRCEM Intermediate

Aim

• To improve patient outcomes and safety, i.e. reduce morbidity and mortality.
• To Improved prescribing patterns: decreased antimicrobial use or increased appropriate use
• To prevent antimicrobial resistance.
• To reduce adverse drug events.
• Assists in controlling outbreaks of multi-resistant organisms (where infection control does not)
• To reduce health care-related costs.
• Some evidence for reduced LOS

TIPS FOR IMPROVING ANTIBIOTIC USE

7 actions to improve antibiotic prescribing and use

1. Obtain cultures before starting therapy
2. Use Therapeutic Guidelines: Antibiotic
3. Document indication and review date
4. Review and reassess antibiotics at 48 hours
5. Consider IV to oral switch
6. Seek advice for complex cases
7. Educate patients about antibiotic use

MINDME: The antimicrobial creed

• M – Microbiology guides therapy
• I – Indications should be evidence based
• N – Narrowest spectrum required
• D – Dosage appropriate to the site and type of infection
• M – Minimise duration of therapy
• E – Ensure monotherapy in most cases

STOPPING ANTIBIOTICS

In general, based on the therapeutic response and microbiology data, antibiotic therapy should be:

• stopped in patients unlikely to have infections
• undergo focusing and narrowing of treatment once the responsible pathogen is known
• switched to monotherapy after day 3 whenever possible
• discontinued after ~7 days for most patients

Longer duration of antibiotics is preferred in certain situations:

• immunosuppressed
• infections with multiresistant microorganisms
• deteriorating course despite treatment
• initial antibiotic regimen was inappropriate for the responsible pathogens

Drawbacks of prolonged antibiotic use include:

• facilitates colonization with antibiotic-resistant bacteria
• increased adverse effects

COMBINED ANTIBIOTICS

Multiple antibiotics may be prescribed simultaneously to:

• ensure adequate empiric cover when infective organisms are unknown
• treat multiple known infectious organisms with different antimicrobial sensitivities
• for ‘synergistic effects’