Prescribing antibiotics in the clinical setting

[Pages:78]Prescribing antibiotics in the clinical setting

Nicole Srivastava, Pharm D, BCPS Clinical Pharmacy Specialist, Infectious Diseases Christiana Care Health System

Objectives

Review general principles in antimicrobial therapy

Common organisms Antibiogram Bactericidal vs bacteriostatic Duration of therapy

Review the pharmacology of common antimicrobials

Mechanism of action Spectrum of activity Place in therapy Adverse effects Key points

Gram positive organisms

Gram negative organisms

Anaerobic organisms

Atypical organisms

Legionella Mycoplasma Chlamydophila

Multi Drug Resistant Organisms

E = Enterococcus faecium S = Staphylococcus aureus K = *ESBL producing-Klebsiella and E. coli A = Acinetobacter baumannii P = Pseudomonas aeruginosa E = Enterobacter species

Boucher HW, et al. Clin Infect Dis. 2009;48:1-12.

Common organisms

Site

Meningitis (dependent on age)

Common organisms < 1 month: S. agalactiae, E. coli, L. monocytogenes, Klebsiella 1-23 months: S. pneumoniae, N. meningitidis, S. agalactiae, H. influenzae, E. coli 2-50 years: N. meningitidis, S. pneumoniae > 50 years: N. meningitidis, S. pneumoniae, L. monocytogenes, aerobic GNB Post neurosurgery: aerobic GNB, P. aeruginosa, S. aureus, coag-neg staph

Skin

Coag-neg staph, S. aureus, Streptococcus , Corynebacterium, Propionibacterium

Oral cavity

Viridans streptococci, Peptococcus, Peptostreptococcus, Eikenella, Haemophilus

CAP: S. pneumoniae, H. influenzae, M. pneumoniae, C. pneumoniae, Legionella +/- S. aureus and aerobic GNB

Pneumonia

HAP: S. pneumoniae, H. influenzae, E. coli, K. pneumoniae, Enterobacter, Proteus, Serratia, S. aureus, P. aeruginosa, Acinetobacter

HCAP: HAP organisms + atypical organisms

Available from: . Accessed on: 12 September 2012

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