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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
- Obtain cultures before starting therapy
- Use Therapeutic Guidelines: Antibiotic
- Document indication and review date
- Review and reassess antibiotics at 48 hours
- Consider IV to oral switch
- Seek advice for complex cases
- 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’
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