Scribd
Upload
22 views

Rational Use of Antimicrobial Agents

The document provides guidelines for the rational use of antimicrobial agents. It recommends that antibiotics only be prescribed when needed and not for conditions typically caused by viruses. Empirical therapy should be based on the type of infection, likely causes, and local antibiogram, and modified based on culture results. Proper administration including dosage, infusion procedures, and stopping treatment at the appropriate time is important. Microbial susceptibility testing and minimum inhibitory concentration guides can help select the most suitable antibiotic. Combinations or antibiotics that are overlapping, redundant, ineffective, or inferior should be avoided.

Uploaded by

Jay Patil
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
22 views

Rational Use of Antimicrobial Agents

The document provides guidelines for the rational use of antimicrobial agents. It recommends that antibiotics only be prescribed when needed and not for conditions typically caused by viruses. Empirical therapy should be based on the type of infection, likely causes, and local antibiogram, and modified based on culture results. Proper administration including dosage, infusion procedures, and stopping treatment at the appropriate time is important. Microbial susceptibility testing and minimum inhibitory concentration guides can help select the most suitable antibiotic. Combinations or antibiotics that are overlapping, redundant, ineffective, or inferior should be avoided.

Uploaded by

Jay Patil
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 1

Rational Use of Antimicrobial Agents

1.Prescribed only when Needed


Condition where antibiotics are not required
Diarrhea: Treat with oral rehydration solution as the primary approach.
Upper Respiratory Tract Infection: Typically caused by viral infections; antibiotics
rarely needed, except for streptococcal or diphtheria cases.
Prophylaxis: Routine antibiotic prophylaxis generally unnecessary, except for
cotrimoxazole prophylaxis in HIV-infected individuals.

2.Culture of cultures and Site – specific Antimicrobials:


Start antibiotics only after collecting site-specific specimens for
culture.
Antibiotics prescribed should be active at the infection site
a. Lungs: Avoid Daptomycin.
b. CSF: Avoid 1st/2nd-gen cephalosporins, tetracyclines, clindamycin.
3.Empirical vs Targeted Therapy
c. Urine: Avoid chloramphenicol, clindamycin.
Empirical therapy initiation based on:
a. Type of Infective Syndrome
b. Common Etiological Bacterial Agents
c. Local Antibiogram

Pathogen-Directed Therapy:
Modify empirical therapy based on Antimicrobial Susceptibility Test (AST) report:
a. Escalation: If AST report indicates resistance, escalate to a higher-ranked
antibiotic.
b. De-escalation: If AST report shows susceptibility, consider de-escalating to a
narrow-spectrum antibiotic.

4.Avoid Administration Errors


Ensure correct dosage based on:
Age, body weight, frequency, and therapy duration.
Loading Dose:
Some antimicrobials (e.g., aminoglycosides, vancomycin, colistin)
may require a loading dose.
Infusion:
Certain antimicrobials (like vancomycin) are mixed with saline
and administered as IV infusion for 2-3 days.
Renal Adjustment:
Adjust dosage of nephrotoxic drugs based on creatinine clearance.
5.Timely stoppage of Antimicrobial
Antimicrobial agents must be stopped at appropriate time mostly
after obtaining negative culture or by use of biomarkers
6.MIC – Guided Therapy
Essential for specific clinical conditions:
Endocarditis, Meningitis, Pneumonia
MIC assists in selecting the most suitable antibiotic
from the susceptible options.

7.Misuse of antimicrobials
Avoid Overlapping Spectra:
Do not prescribe a combination of Meropenem and piperacillin-tazobactam
(both are beta-lactams).
Redundant Antibiotics:
Avoid prescribing Meropenem and Metronidazole for anaerobic infections
(Meropenem is active against anaerobes and gram-negative bacteria).
Ineffective Antibiotics:
Do not use Cloxacillin in MRSA; Vancomycin is the drug of choice.
Inferior Antibiotics:
Avoid using Vancomycin for MRSA infections; Cloxacillin is more effective.

REFERENCE - Apurba Sankar Sastry 4th Edition book

You might also like