SOHM LIBRARY - SOHM Library



Teaching Script Author: Andrea Hadley, MDTopic: Parenteral antibiotic duration for infants with bacteremic UTIIdentify the TriggerBased on patient situation/learnerLearner states that an infant with bacteremic UTI will need at least 10 days of parenteral antibiotics for treatment.High Yield Teaching PointWhat do they need to know that will impact their care of patients?Shorter courses of parenteral antibiotic therapy with early conversion to oral antibiotics may be considered in this population, especially in those infants who are well-appearing.Identify EBMFind your sources and specific evidenceDesai S, Aronson PL, Shabanova V, et al. Parenteral Antibiotic Therapy Duration in Young Infants with Bacteremic Urinary Tract Infections. Pediatrics. 2019; 144(3):e20183844. There is evidence that infants less than 60 days of age with bacteremic UTIs who are treated with shorter (<7 days) courses of parenteral antibiotics have similar low risk of 30-day UTI recurrence and 30-day all-cause reutilization compared to infants treated with longer (>7 days) courses of parenteral antibiotics. Half of the patients who received shorter courses were treated with 4-7 days of parenteral antibiotics, with 7 days being the most common duration.Describe StrategyInteractive, analogies, visualsInteractive Q&A/Brainstorming session (see below) for guide.Keep Script Brief3-5 minutes; what are your key pointsSo, what are the pros and cons of treating with a full 10 day course of parenteral antibiotics versus transitioning to oral early? Ask learners to make a table on the board, blank paper, or dry erase marker on the window to answer the question “What are the pros and cons of keeping the child in the hospital for a full 10 days of parenteral antibiotics.” Example shown below.After creation of the table, ask if anyone knows any study that could support the early transition? If not, offer your high yield teaching point.ProConUnable to ensure compliance with oral antibiotics after dischargeIncreased risk of adverse drug effects (nephrotoxicity, etc.)Parenteral antibiotics with known bioavailability whereas unknown bioavailability of oral antibiotics in this age group (<60 days of age)Increased health care costs due to lengthy admission and treatmentThere is Inadequate data for oral treatment of UTI in non-E.coli organism, ill appearing infant, or infants with anatomic abnormalities/hydronephrosis/VURRisk for other development of hospital acquired conditions or line related complications (infections, VTE)Risk for readmission which is costlyInterruption of family bondingUnable to ensure adherence to recommended outpatient follow-up planSafe early transition to oral antibiotics has been shown for other pediatric infections including osteomyelitis, complicated CAPNo evidence regarding optimal type of oral antibiotic or total duration after dischargeInfants with bacteremic UTI treated with shorter courses of parenteral antibiotics (<7 days) have similar rates of recurrence and reutilization compared to those treated with longer courses. Potential need for multiple attempts at IV during hospital course (painful)Adapted from Lang. et al. Collaborative development of teaching scripts: an efficient faculty development approach for a busy clinical teaching unit. J Hosp Med. 2012; Oct 7(8): 644-8.Please click to complete a short 2-minute survey! Teaching Script ID #: 23 HYPERLINK "" ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download