Antimicrobial prescribing – what
we tell the “young” doctors
Robert Laing MD FRCPE
Consultant Infectious Disease Physician,
Aberdeen Royal Infirmary, Scotland
Disclosure
No conflict of interest to disclose
When to start an antibiotic
SUSPECTED BACTERIAL INFECTION
Pulse >90
Systemic Inflammatory Response Syndrome Temp 38
RR > 20
WCC > 12 or <5
+ evidence of
SIRSSIRS +
Sepsis
bacterial infection
Bacterial Isolate
Organ under-perfusion
organ underperfusion -
Severe Sepsis confusion, acidosis
oliguria, confusion, acidosis
Irreversible hypotension
irreversible hypotension Septic Shock
despite fluid resuscitation
despite fluid resuscitation
What to do?
Culture
Fluids
Oxygen
antibiotics
How to start an antibiotic
Minimum dataset
– SIRS documentation
– IV or oral
– Dose & frequency
– Anticipated duration/review date
Choosing an antibiotic
Any to avoid??
Organism
C diffogenic antimicrobials should be
avoided where possible
Site Cephalosporins (third generation)
Clindamycin
Co-amoxiclav
Host
Ciprofloxacin
Bactericidal vs Bacteriostatic
Choice by site – location, location
Gram pos
– SSTI, bone, line
Gram negative
– Biliary tract, UTI, bowel
Healthcare or community acquired
Treatment by host
Allergy
Renal Function
– Creatinine clearance
Drug Interactions
Other medical conditions
– epilepsy
Pregnancy
Antimicrobial Prescribing Bundle Compliance - Example Ward (5 patients/week)
100%
90%
80%
70%
Percentage Compliance
60%
50%
40%
30%
20%
10%
0%
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
Week
Record of indication/site of infection Name of antib iotic(s)
Route Do se
Frequency Review date/ Stop date/ Duratio n
Compliance with empirical guideline or according to micro biology results or advice Bundle Co mpliant
Drug Kardex Documentation
Antimicrobial
Prescribing
Gillian Macartney
Lynne Dowswell
Antibiotic Pharmacists
Tel 51048 Bleep 2463