Choosing the Best Antibiotic in Problem Outpatient Infectious Disease Cases
|
|
- Nickolas Ross
- 5 years ago
- Views:
Transcription
1 Choosing the Best Antibiotic in Problem Outpatient Infectious Disease Cases Dr. Earl Rubin Associate Professor Department of Pediatrics Division of Infectious Diseases Montreal Children s Hospital
2 Disclosures Have served previously on Advisory Boards for Novartis, Roche, Pfizer but NONE in the past 5 years
3 Ouch, my ear isn t getting better! 3 year old male, previously healthy, except for an AOM 2 months previous to presentation. Presents on day 2 of left ear pain, and 1 day of fever Had a preceeding URI the week prior to the onset of the ear pain
4 No doubt about the diagnosis
5 AOM is a Symptomatic Disease Antecedent URTI in 93% Compared with a simple URTI children with AOM are somewhat or much more likely to have: Ear pain in a verbal child and/or Fever Nighttime restlessness Irritability Faden PIDJ 1998, Kontiokari PIDJ 1998
6 Mom has some requests This can be a stubborn child who often refuses to take his medication The preschool will not administer meds to him She requests a once a day medication if possible.
7 Once daily choices 14 drugs approved by the FDA for the use in AOM The following are given once daily: Cefixime (Suprax) Azithromycin (Zithromax) IV/IM Ceftriaxone Which do you prefer and why?
8 Time for patient education Convince the mother that amoxicillin is really the treatment of choice Studies have shown that bid dosing is sufficient to treat otitis media The issue is the dose Regular dose: mg/kg/day High dose: mg/kg/day
9 The child weighs 15 kg Regular dose: mg/kg/day mg/day 250 mg/5cc Therefore 6 to 9 cc twice daily High dose: mg/kg/day mg/day cc twice daily Of interest, in the US, the amoxicillin also comes as 400 mg/5cc!
10 Compromise is reached Regular dose amoxicillin given twice daily The child returns after 36 hours with ongoing fever, and now both ears hurt
11 Etiology of AOM: Bacteria GAS 3% M. catarrhalis 14% No growth 25% H. influenzae 22% S. pneumoniae 36%
12 H. Influenzae ß lactamase production H.Influenzae (22%) ß + 34% ß - 66%
13 M.catarrhalis ß lactamase production M. catarrhalis (14%) ß + 85% ß - 15%
14 PENICILLIN RESISTANT PNEUMOCOCCUS GAS NO GROWTH PENICILLIN RESISTANT PNEUMOCOCCUS sensitive 80-95% resistant 5-20% H.FLU M.CAT PNEUMO
15 Overcome resistance with dose
16 WHAT ABOUT AOM DUE TO Pen NON Suscpetible PNEUMO? DEFINITION: MIC <0.06 : sensitive 0.1-1: intermediate >2: high level resistant Sensitivity is NOT all or none, as with betalactamase, but can be overcome with higher doses
17 SPONTANEOUS RESOLUTION PATHOGEN DEPENDENT % RESOLUTION STREPTOCOCCUS PNEUMONIAE 19% H. INFLUENZAE 48% M. CATARRHALIS 79% Reference: McCraken GH, PIDJ, 13 (11):1054
18 WHAT DID THE REGULAR DOSE AMOXICILLIN NOT ADEQUATELY COVER? ß lactamase producing organisms 34 % of H. influenzae 34% of 22% = 7.5% BUT 48% resolve spontaneously THEREFORE ACCOUNTS FOR 3.9% OF FAILURES 85% of M. catarrhalis 85% of 14% = 12% BUT 79% resolve spontaneously THEREFORE ACCOUNTS FOR 2.5% OF FAILURES
19 WHAT DID THE AMOXICILLIN NOT ADEQUATELY COVER? PENICILLIN RESISTANT PNEUMOCOCCUS ~ 10-15% of 36%= % BUT 21% resolve spontaneously THEREFORE ACCOUNTS FOR % OF FAILURES
20 Overall failure of Regular dose amoxicillin About 4% due to H. flu About 2.5% due to M. cat About 3.5% due to Pneumococcus Therefore a 10% clinical failure rate Of which 65% are due to Beta lactamase production
21 What should your 2 nd line therapy then be? Beta lactamase stable agent 2 nd or 3 rd generation cephalosporin Cefprozil Cefuroxime axetil Cefixime Non-Beta-lactam Azithromycin Clarithromycin Combination with Beta lactamase inhibitor Amoxicillin-Clavulanic acid (regular dose)
22 What should your 2 nd line therapy then be? Double dose amoxicillin Combination of both high dose amoxicillin with a Beta lactamase inhibitor
23 Amoxicillin-Clavulanate Suspension 4:1 ratio of amoxil to clavulanate 125 mg/5cc 250 mg/5cc 7:1 ratio 200 or 400 mg/5cc In USA: 14:1 ratio called Augmentin ES Can mimic this with combining regular dose amoxil at 40 mg/kg/day with 7:1 clavulin at 40 mg/kg/day
24 Amoxicillin-Clavulanate Tablets All the tablets have the same amount of Clavulanic acid, 125 mg as Potassium salt Therefore the ratio of amoxil to clav is very different depending on the tab prescribed 250 mg tabs have a ratio of 2:1 500 mg tabs have the ratio of 4:1 To get the 7:1 ratio, the tab is 875 mg, but is very large! Therefore 2 x 250 does NOT equal 500!
25 Practically speaking, what should you do? Greatest bang for your buck will be the combination of amoxil with the 7:1 Clavulin Be very specific and write out your logic in the prescription, so the pharmacist does not call you! Difficulties? 80 mg/kg of the 7:1 Clavulin, warn about the price and increased diarrhea Try any other second line agent, and if this fails, the 3 rd line would be double dose amoxicillin
26 Should we have started with High dose amoxicillin? CDC now recommends this Higher rates of Penicillin non susceptible Pneumococci Use high dose if risk factors for PRP Previous antibiotic use in the last 1-3 months Attendance at an out of home daycare If you start with HD amoxicillin Second line agent could be almost anything Resistance would be beta lactamase induced
27 Quiz: What would your second line therapy be, should the following fail? Regular dose amoxicillin? Double dose amoxicillin? 2 nd or 3 rd generation cephalosporin? Macrolide?
28 Any questions?
29 My throat really hurts! Previously well 5 year old female, at 3 pm complains of a sore throat and fever to 40 At 6 pm, she has a normal exam except for a red throat with pus, petechiae on the palate, and tender tonsillar nodes Rapid strep test is negative What do you do now?
30 Pharyngitis Formal throat culture is taken What do you want to do now? Start Penicillin Wait on the culture results By the way, he is Penicillin allergic
31 False negative rapid strep Next day the preliminary culture comes back positive for beta hemolytic group A strep Your choice of antibiotic? Azithromycin 10 mg/kg on day 1, then 5 mg/kg on days 2-5 Clarithromycin 15 mg/kg/day bid, for 10 days Erythromycin or other choice? Proper dose of Azithromycin is 12 mg/kg/day for 5 days!
32 Next day she is no better! Generally speaking after 24 hours of treatment, you should almost be perfect! Potentially reason for slow response? Has a viral illness, and is a strep carrier Resistant to treatment choice Has a suppurative complication, retropharyngeal cellulitis/abscess Has EBV
33 Lab calls The Group A streptococcus is penicillin sensitive, but resistant to erythromycin and clindamycin (inducible resistance) You ask about Azithro/Clarithro About 5-10% are macrolide resistant, 0% are penicillin resistant
34 You call the patient back Throat looks terrible (but no shift of the uvula) and big cervical nodes This penicillin allergy was to cloxacillin, it was a pinpoint rash that lasted 2 days. The child received pondocillin afterwards for an otitis media without problems What do you want to do? Give the child amoxicillin Give the child penicillin Stop all therapy because it is viral
35 Not again! Mom calls you the next day because the child has a red rash all over!
36 What do you think is going on? Penicillin allergy? Viral exanthem Amoxicillin associated rash of EBV Happens in 85-95% of cases of amoxil in the face of EBV Hypersensitivity reaction Reported with many antibiotics but lower frequency
37 Monospot is positive Do you want to discontinue all antibiotics? Rate of GAS in mononucleosis ranges from 3-33% Older literature suggest to treat the GAS Some newer studies say that it may not be necessary Controversial
38 Any questions?
39 My baby s urine smells disgusting! 18 month old, with known grade III VUR, is on Septra prophylaxis Presents with a 3 day history of fever, and some loose stool Urine dipstick is positive for leukocytes 3+, and RBCs 2+, and nitrite positive You send her to the ER for a catheterized urine culture, and you start her on?
40 Common Antibiotic choices for UTIs in children Amoxicillin Septra/Bactrim Cephalexin Amoxicillin/clavulanic acid Cefixime (Suprax)
41 Next day, the lab calls Greater than 10 8 of E. coli You call the patient, and still has fever after 2 doses What do you do? Next day, the lab calls and tells you that the preliminary sensitivities: Resistant to ampicillin, cephalothin, septra, clavulin, cefixime Sensitive to gentamicin, tobramycin, amikacin They tell you that tomorrow some other sensitivities. What kind of E. coli do you think this is?
42 What the heck is an ESBL/KPC/CRE? Extended Spectrum Beta Lactamase Seen with E. coli and Klebsiella Resistant to all Beta Lactams Combination drugs with beta lactamase inhibitors are also ineffective Klebsiella Producing Carbapenemases/Carbapenemas resisitant enterobacteracieae Resisant to carbapenems as well as multiple others
43 What choice do I have? Once daily aminoglycoside (IV) Need to arrange home care Quinolones, ie. Cipro Not approved for the use in Pediatrics Many ESBL/KPCs are also resistant Carbepenems Ertapenem is once daily if >12 years, otherwise it is bid
44 What do I do as far as prophylaxis after this UTI? Go back to Septra Go to Nitrofurantoin Go to quinolone Go to amoxicillin Since this E. coli was resistant, there is no prophylaxis to choose from
45 Any questions?
Approach to pediatric Antibiotics
Approach to pediatric Antibiotics Gassem Gohal FAAP FRCPC Assistant professor of Pediatrics objectives To be familiar with common pediatric antibiotics o Classification o Action o Adverse effect To discus
More information11/10/2016. Skin and Soft Tissue Infections. Disclosures. Educational Need/Practice Gap. Objectives. Case #1
Disclosures Selecting Antimicrobials for Common Infections in Children FMR-Contemporary Pediatrics 11/2016 Sean McTigue, MD Assistant Professor of Pediatrics, Pediatric Infectious Diseases Medical Director
More informationPrescribing Guidelines for Outpatient Antimicrobials in Otherwise Healthy Children
Prescribing Guidelines for Outpatient Antimicrobials in Otherwise Healthy Children Prescribing Antimicrobials for Common Illnesses When treating common illnesses such as ear infections and strep throat,
More informationAppropriate Management of Common Pediatric Infections. Blaise L. Congeni M.D. Akron Children s Hospital Division of Pediatric Infectious Diseases
Appropriate Management of Common Pediatric Infections Blaise L. Congeni M.D. Akron Children s Hospital Division of Pediatric Infectious Diseases It s all about the microorganism The common pathogens Viruses
More informationPerichondritis: Source: UpToDate Ciprofloxacin 10 mg/kg/dose PO (max 500 mg/dose) BID Inpatient: Ceftazidime 50 mg/kg/dose q8 hours IV
Empiric Antibiotics for Pediatric Infections Seen in ED NOTE: Choice of empiric antibiotic therapy must take into account local pathogen frequency and resistance patterns, individual patient characteristics,
More informationSimilar to Penicillins: -Chemically. -Mechanism of action. -Toxicity.
Similar to Penicillins: -Chemically. -Mechanism of action. -Toxicity. Cephalosporins are divided into Generations: -First generation have better activity against gram positive organisms. -Later compounds
More informationAdvanced Practice Education Associates. Antibiotics
Advanced Practice Education Associates Antibiotics Overview Difference between Gram Positive(+), Gram Negative(-) organisms Beta lactam ring, allergies Antimicrobial Spectra of Antibiotic Classes 78 Copyright
More information2016 Antibiotic Susceptibility Report
Fairview Northland Medical Center and Elk River, Milaca, Princeton and Zimmerman Clinics 2016 Antibiotic Susceptibility Report GRAM-NEGATIVE ORGANISMS 2016 Gram-Negative Non-Urine The number of isolates
More informationTelephone Max dose amoxicillin pediatrics P.O. Box 189 Navan, ON, K4B 1J4 Canada. Sitemap
Telephone 613-835-9490 Max dose amoxicillin pediatrics P.O. Box 189 Navan, ON, K4B 1J4 Canada Sitemap 25 mg/kg/ dose ( Max : 500 mg/ dose ) PO twice daily for 10 days is recommended by the Infectious Diseases
More information2015 Antibiotic Susceptibility Report
Citrobacter freundii Enterobacter aerogenes Enterobacter cloacae Escherichia coli Haemophilus influenzenza Klebsiella oxytoca Klebsiella pneumoniae Proteus mirabilis Pseudomonas aeruginosa Serratia marcescens
More informationnumber Done by Corrected by Doctor Dr.Malik
number 27 Done by Fatimah Farhan Corrected by Basil Al-Bakri Doctor Dr.Malik Note: anything in red is just extra info and you will not be asked about it in the exam. In this sheet we will continue talking
More informationRational management of community acquired infections
Rational management of community acquired infections Dr Tanu Singhal MD, MSc Consultant Pediatrics and Infectious Disease Kokilaben Dhirubhai Ambani Hospital, Mumbai Why is rational management needed?
More informationThe β- Lactam Antibiotics. Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018
The β- Lactam Antibiotics Munir Gharaibeh MD, PhD, MHPE School of Medicine, The University of Jordan November 2018 Penicillins. Cephalosporins. Carbapenems. Monobactams. The β- Lactam Antibiotics 2 3 How
More informationPharmacology Week 6 ANTIMICROBIAL AGENTS
Pharmacology Week 6 ANTIMICROBIAL AGENTS Mechanisms of antimicrobial action Mechanisms of antimicrobial action Bacteriostatic - Slow or stop bacterial growth, needs an immune system to finish off the microbe
More informationSuggestions for appropriate agents to include in routine antimicrobial susceptibility testing
Suggestions for appropriate agents to include in routine antimicrobial susceptibility testing These suggestions are intended to indicate minimum sets of agents to test routinely in a diagnostic laboratory
More informationChildrens Hospital Antibiogram for 2012 (Based on data from 2011)
Childrens Hospital Antibiogram for 2012 (Based on data from 2011) Prepared by: Department of Clinical Microbiology, Health Sciences Centre For further information contact: Andrew Walkty, MD, FRCPC Medical
More informationAntibiotic. Antibiotic Classes, Spectrum of Activity & Antibiotic Reporting
Antibiotic Antibiotic Classes, Spectrum of Activity & Antibiotic Reporting Any substance of natural, synthetic or semisynthetic origin which at low concentrations kills or inhibits the growth of bacteria
More informationTreatment of Respiratory Tract Infections Prof. Mohammad Alhumayyd Dr. Aliah Alshanwani
Treatment of Respiratory Tract Infections Prof. Mohammad Alhumayyd Dr. Aliah Alshanwani 30-1-2018 1 Objectives of the lecture At the end of lecture, the students should be able to understand the following:
More informationRational use of antibiotic in upper respiratory tract infection (URI) and community acquired pneumonia รศ.จามร ธ รตก ลพ ศาล 23 พฤษภาคม 2550
Rational use of antibiotic in upper respiratory tract infection (URI) and community acquired pneumonia รศ.จามร ธ รตก ลพ ศาล 23 พฤษภาคม 2550 Sinusitis Upper respiratory tract infections (URI) Common cold
More information** the doctor start the lecture with revising some information from the last one:
Page 1 of 7 ** the doctor start the lecture with revising some information from the last one: #penicillin G has a good susceptibility against gram(+ve), Neisseria (-ve) #mostly active against strep. (don
More informationMercy Medical Center Des Moines, Iowa Department of Pathology. Microbiology Department Antibiotic Susceptibility January December 2016
Mercy Medical Center Des Moines, Iowa Department of Pathology Microbiology Department Antibiotic Susceptibility January December 2016 These statistics are intended solely as a GUIDE to choosing appropriate
More informationa. 379 laboratories provided quantitative results, e.g (DD method) to 35.4% (MIC method) of all participants; see Table 2.
AND QUANTITATIVE PRECISION (SAMPLE UR-01, 2017) Background and Plan of Analysis Sample UR-01 (2017) was sent to API participants as a simulated urine culture for recognition of a significant pathogen colony
More informationAntibiotic Updates: Part II
Antibiotic Updates: Part II Fredrick M. Abrahamian, DO, FACEP, FIDSA Health Sciences Clinical Professor of Emergency Medicine David Geffen School of Medicine at UCLA Los Angeles, California Financial Disclosures
More informationNational Clinical Guideline Centre Pneumonia Diagnosis and management of community- and hospital-acquired pneumonia in adults
National Clinical Guideline Centre Antibiotic classifications Pneumonia Diagnosis and management of community- and hospital-acquired pneumonia in adults Clinical guideline 191 Appendix N 3 December 2014
More informationInteractive session: adapting to antibiogram. Thong Phe Heng Vengchhun Felix Leclerc Erika Vlieghe
Interactive session: adapting to antibiogram Thong Phe Heng Vengchhun Felix Leclerc Erika Vlieghe Case 1 63 y old woman Dx: urosepsis? After 2 d: intermediate result: Gram-negative bacilli Empiric antibiotic
More informationce lesson Optimizing antibiotic therapy for common childhood respiratory infections By Susanne Moadebi, BSc Pharm, Pharm.D.
Approved BY CCCEP FOR 1.5 CEUs CCCEP file #896-0309 This lesson has been approved for 1.5 CEUs by the Canadian Council on Continuing Edu ca tion in Pharmacy. Approved for 1.5 CEUs by l Ordre des pharmaciens
More informationLet me clear my throat: empiric antibiotics in
Let me clear my throat: empiric antibiotics in respiratory tract infections Alexander John Langley, MD MS MPH Goals of this talk Overuse of antibiotics is a major issue, as a result many specialist medical
More information10/9/2017. Evidence-Based Interventions to Reduce Inappropriate Prescription of Antibiotics. Prescribing for Respiratory Tract Infections
Evidence-Based Interventions to Reduce Inappropriate Prescription of Antibiotics Ann Thomas, MD, MPH Oregon Public Health Division Prescribing for Respiratory Tract Infections Antibiotic use is primary
More informationANTIBIOTICS ACUTE OTITIS MEDIA (AOM) IN CHILDREN 3 MONTHS OF AGE OR OLDER GENERAL INFORMATIONS PREVENTIVE MEASURES DIAGNOSIS
MARCH 206 DRUG ANTIBIOTICS This optimal usage guide is mainly intended f primary care health professionnals. It is provided f infmation purposes only and should not replace the clinician s judgement. The
More informationPrinciples of Infectious Disease. Dr. Ezra Levy CSUHS PA Program
Principles of Infectious Disease Dr. Ezra Levy CSUHS PA Program I. Microbiology (1) morphology (e.g., cocci, bacilli) (2) growth characteristics (e.g., aerobic vs anaerobic) (3) other qualities (e.g.,
More informationVolume. December Infection. Notes. length of. cases as 90% 1 week. tonsillitis. First Line. sore throat / daily for 5 days. quinsy >4000.
Volume 8; Number 22 LINCOLNSHIRE GUIDELINES FOR THE TREATMENT OF COMMONLYY OCCURRING INFECTIONS IN PRIMARY CARE: WINTER 2014/15 In this issue of the PACE Bulletin we present an update of our Guidelines
More informationGENERAL NOTES: 2016 site of infection type of organism location of the patient
GENERAL NOTES: This is a summary of the antibiotic sensitivity profile of clinical isolates recovered at AIIMS Bhopal Hospital during the year 2016. However, for organisms in which < 30 isolates were recovered
More informationBacterial Resistance of Respiratory Pathogens. John C. Rotschafer, Pharm.D. University of Minnesota
Bacterial Resistance of Respiratory Pathogens John C. Rotschafer, Pharm.D. University of Minnesota Antibiotic Misuse ~150 million courses of antibiotic prescribed by office based prescribers Estimated
More informationUpdate on Fluoroquinolones. Charles Krasner, M.D. June 16, 2016 Antibiotic Stewardship Program -ECHO
Update on Fluoroquinolones Charles Krasner, M.D. June 16, 2016 Antibiotic Stewardship Program -ECHO Potential fluoroquinolone side-effects Increased risk, greater than with most other antibiotics, for
More informationAntibiotic Abyss. Discussion Points. MRSA Treatment Guidelines
Antibiotic Abyss Fredrick M. Abrahamian, D.O., FACEP, FIDSA Professor of Medicine UCLA School of Medicine Director of Education Department of Emergency Medicine Olive View-UCLA Medical Center Sylmar, California
More informationVolume 1; Number 7 November 2007
Volume 1; Number 7 November 2007 CONTENTS Page 1 Page 3 Guidance on the Use of Antibacterial Drugs in Lincolnshire Primary Care: Winter 2007/8 NICE Clinical Guideline 54: Urinary Tract Infection in Children
More informationQuality ID #66: Appropriate Testing for Children with Pharyngitis National Quality Strategy Domain: Efficiency and Cost Reduction
Quality ID #66: Appropriate Testing for Children with Pharyngitis National Quality Strategy Domain: Efficiency and Cost Reduction 2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY MEASURE TYPE: Process
More informationSupplementary Online Content
Supplementary Online Content Gerber JS, Prasad PA, Fiks AG, et al. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians:
More informationCell Wall Weakeners. Antimicrobials: Drugs that Weaken the Cell Wall. Bacterial Cell Wall. Bacterial Resistance to PCNs. PCN Classification
Cell Wall Weakeners Antimicrobials: Drugs that Weaken the Cell Wall Beta Lactams Penicillins Cephalosporins Carbapenems Aztreonam Vancomycin Teicoplanin Bacterial Cell Wall Bacterial cytoplasm is hypertonic
More informationAntimicrobial Stewardship in the Long Term Care and Outpatient Settings. Carlos Reyes Sacin, MD, AAHIVS
Antimicrobial Stewardship in the Long Term Care and Outpatient Settings Carlos Reyes Sacin, MD, AAHIVS Disclosure Speaker and consultant in HIV medicine for Gilead and Jansen Pharmaceuticals Objectives
More information10/13/14. Low: not well absorbed. Good: [blood and tissue] < than if given IV. High: > 90% absorption orally
Low: not well absorbed PO agent not for serious infection nitrofurantoin Good: [blood and tissue] < than if given IV [Therapeutic] in excess of [effective] eg. cephalexin High: > 90% absorption orally
More informationInvasive Group A Streptococcus (GAS)
Invasive Group A Streptococcus (GAS) Cause caused by a bacterium commonly found on the skin and in the throat transmitted by direct, indirect or droplet contact with secretions from the nose, and throat
More informationciprofloxacin and amoxicillin taken togather, amoxicillin absorbtion amount, leukopenia caused by antibiotic amoxicillin sun and amoxicillin.
ciprofloxacin and amoxicillin taken togather, amoxicillin absorbtion amount, leukopenia caused by antibiotic amoxicillin sun and amoxicillin. amoxicillin icd 9 code amoxicillin small intestine overgrowth
More informationAntimicrobial Update. Alison MacDonald Area Antimicrobial Pharmacist NHS Highland April 2018
Antimicrobial Update Alison MacDonald Area Antimicrobial Pharmacist NHS Highland alisonc.macdonald@nhs.net April 2018 Starter Questions Setting the scene... What if antibiotics were no longer effective?
More informationCLINICAL USE OF BETA-LACTAMS
CLINICAL USE OF BETA-LACTAMS Douglas Black, Pharm.D. Associate Professor School of Pharmacy University of Washington dblack@u.washington.edu WHY IS INFECTIOUS DISEASE PHARMACOTHERAPY SO CONFUSING? Microbial
More informationUpdated recommended treatment regimens for gonococcal infections and associated conditions United States, April 2007
Updated recommended treatment regimens for gonococcal infections and associated conditions United States, April 2007 1 Ongoing data from CDC 's Gonococcal Isolate Surveillance Project (GISP), including
More informationAntimicrobial Susceptibility Testing: Advanced Course
Antimicrobial Susceptibility Testing: Advanced Course Cascade Reporting Cascade Reporting I. Selecting Antimicrobial Agents for Testing and Reporting Selection of the most appropriate antimicrobials to
More informationß-lactams. Sub-families. Penicillins. Cephalosporins. Monobactams. Carbapenems
β-lactams ß-lactams Sub-families Penicillins Cephalosporins Monobactams Carbapenems ß-lactams Mode of action PBPs = Trans/Carboxy/Endo- peptidases PBP binding (Penicillin-Binding Proteins) activation of
More informationMedicinal Chemistry 561P. 2 st hour Examination. May 6, 2013 NAME: KEY. Good Luck!
Medicinal Chemistry 561P 2 st hour Examination May 6, 2013 NAME: KEY Good Luck! 2 MDCH 561P Exam 2 May 6, 2013 Name: KEY Grade: Fill in your scantron with the best choice for the questions below: 1. Which
More informationAmoxicillin clavulanic acid spectrum
Cari untuk: Cari Cari Amoxicillin clavulanic acid spectrum 14-8-2017 Amoxicillin and clavulanate potassium (AMC), also known as augmentin, is an antibiotic used to treat bacterial infections. AMC is available
More informationOutpatient Antimicrobial Therapy. Role of Antibacterials in Outpatient Treatment of Respiratory Tract Infection. Acute Bacterial Rhinosinusitis
Outpatient Antimicrobial Therapy B. Joseph Guglielmo, Pharm.D. Professor and Chair Department of Clinical Pharmacy University of California San Francisco Role of Antibacterials in Outpatient Treatment
More informationRational use of antibiotics
Rational use of antibiotics Uga Dumpis MD, PhD,, DTM Stradins University Hospital Riga, Latvia ugadumpis@stradini.lv BALTICCARE CONFERENCE, PSKOV, 16-18.03, 18.03, 2006 Why to use antibiotics? Prophylaxis
More informationGLOBAL ANTIBIOTIC RESEARCH & DEVELOPMENT PARTNERSHIP
GLOBAL ANTIBIOTIC RESEARCH & DEVELOPMENT PARTNERSHIP CO-AMOXICLAV (AMOXICILLIN + CLAVULANATE) Dr. Marie-Claude BOTTINEAU Dr. Emmanuel BARON Summary of global estimates (CHERG 2013) ~ 6.6 million deaths
More information2019 COLLECTION TYPE: MIPS CLINICAL QUALITY MEASURES (CQMS) MEASURE TYPE: Process High Priority
Quality ID #66: Appropriate Testing for Children with Pharyngitis National Quality Strategy Domain: Efficiency and Cost Reduction Meaningful Measure Area: Appropriate Use of Healthcare 2019 COLLECTION
More informationAn Approach to Appropriate Antibiotic Prescribing in Outpatient and LTC Settings?
An Approach to Appropriate Antibiotic Prescribing in Outpatient and LTC Settings? Dr. Andrew Morris Antimicrobial Stewardship ProgramMt. Sinai Hospital University Health Network amorris@mtsinai.on.ca andrew.morris@uhn.ca
More information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process
Quality ID #65 (NQF 0069): Appropriate Treatment for Children with Upper Respiratory Infection (URI) National Quality Strategy Domain: Efficiency and Cost Reduction 2018 OPTIONS FOR INDIVIDUAL MEASURES:
More informationSuggested treatment. Inj Crystalline Penicillin 50,000U/Kg i.v. 4-6hrly (if child cannot swallow) 40mg/Kg/dose BID x 10days
GUIDELINES FOR TREATMENT OF INFECTIONS IN CHILDREN A. RESPIRATORY TRACT INFECTIONS UPPER RESPIRATORY TRACT INFECTIONS Infection/Condition/likely organism Suggested treatment Preferred Alternative Acute
More informationRoutine internal quality control as recommended by EUCAST Version 3.1, valid from
Routine internal quality control as recommended by EUCAST Version.1, valid from 01-01-01 Escherichia coli Pseudomonas aeruginosa Staphylococcus aureus Enterococcus faecalis Streptococcus pneumoniae Haemophilus
More informationPneumonia considerations Galia Rahav Infectious diseases unit Sheba medical center
Pneumonia considerations 2017 Galia Rahav Infectious diseases unit Sheba medical center Sir William Osler (1849 1919) "Father of modern medicine Pneumonia: The old man's friend The captain of the men of
More informationPrepared: August Review: July Common Infections. A Medicines Optimisation Antibiotic Prescribing Guide.
Prepared: August 2013 Review: July 2014 Common Infections. A Medicines Optimisation Antibiotic Prescribing Guide. Contents Page: Page No Why do we want to review antibiotics? 2 What do NICE say? 3 Acute
More informationANTIBIOTICS. SCHOOL AGE AND ADOLESCENCE Respiratory viruses Respiratory viruses Respiratory viruses Streptococcus pneumoniae
MARCH 2016 DRUG ANTIBIOTICS This optimal usage guide is mainly intended f primary care health professionnals. It is provided f infmation purposes only and should not replace the clinician s judgement.
More information$100 $200 $300 $400 $500
Skin is In Runny Noses Got to go! Hear no evil It s in the Lungs $100 $100 $100 $100 $100 $200 $200 $200 $200 $200 $300 $300 $300 $300 $300 $400 $400 $400 $400 $400 $500 $500 $500 $500 $500 Double Jeopardy
More informationNew Antibiotics & New Insights into Old Antibiotics
New Antibiotics & New Insights into Old Antibiotics Louisiana Chapter of the American Academy of Pediatrics August 18, 2018 Baton Rouge, Louisiana John Bradley MD Rady Children s Hospital San Diego University
More informationAntibiotics & Common Infections: Stewardship, Effectiveness, Safety & Clinical Pearls. Welcome We will begin shortly.
Antibiotics & Common Infections: Stewardship, Effectiveness, Safety & Clinical Pearls Welcome We will begin shortly. The Canadian Pharmacists Association is pleased to be collaborating with the following
More information21 st Expert Committee on Selection and Use of Essential Medicines Peer Review Report Antibiotics Review
(1) Have all important studies/evidence of which you are aware been included in the application? Yes No Please provide brief comments on any relevant studies that have not been included: (2) For each of
More informationnumber Done by Corrected by Doctor
number 28 Done by Dina Yaseen Corrected by حسام أبو عوض Doctor مالك الزحلف Cephalosporins -Cephalosporins are β-lactam antibiotics isolated from a strain of Streptomyces. -They are bactericidal and work
More informationAberdeen Hospital. Antibiotic Susceptibility Patterns For Commonly Isolated Organisms For 2015
Aberdeen Hospital Antibiotic Susceptibility Patterns For Commonly Isolated s For 2015 Services Laboratory Microbiology Department Aberdeen Hospital Nova Scotia Health Authority 835 East River Road New
More informationAMOCLAN HIKMA PHARMACEUTICALS
09-15 AMOCLAN HIKMA PHARMACEUTICALS (Amoxycillin and Clavulanic acid) ACTION Amoxicillin is a semisynthetic antibiotic with a broad spectrum of bactericidal activity against many gram-positive and gram-negative
More informationجداول میکروارگانیسم های بیماریزای اولویت دار و آنتی بیوتیک های تعیین شده برای آزمایش تعیین حساسیت ضد میکروبی در برنامه مهار مقاومت میکروبی
جداول میکروارگانیسم های بیماریزای اولویت دار و آنتی بیوتیک های تعیین شده برای آزمایش تعیین حساسیت ضد میکروبی در برنامه مهار مقاومت میکروبی ویرایش دوم بر اساس ed., 2017 CLSI M100 27 th تابستان ۶۹۳۱ تهیه
More informationResponsible use of antibiotics
Responsible use of antibiotics Uga Dumpis MD, PhD Department of Infectious Diseases and Infection Control Pauls Stradiņs Clinical University Hospital Challenges in the hospitals Antibiotics are still effective
More information2019 COLLECTION TYPE: MIPS CLINICAL QUALITY MEASURES (CQMS) MEASURE TYPE: Process High Priority
Quality ID #65 (NQF 0069): Appropriate Treatment for Children with Upper Respiratory Infection (URI) National Quality Strategy Domain: Efficiency and Cost Reduction Meaningful Measure Area: Appropriate
More informationCommunity-Associated C. difficile Infection: Think Outside the Hospital. Maria Bye, MPH Epidemiologist May 1, 2018
Community-Associated C. difficile Infection: Think Outside the Hospital Maria Bye, MPH Epidemiologist Maria.Bye@state.mn.us 651-201-4085 May 1, 2018 Clostridium difficile Clostridium difficile Clostridium
More informationJanuary 2014 Vol. 34 No. 1
January 2014 Vol. 34 No. 1. and Minimal Inhibitory Concentration (MIC) Interpretive Standards for Testing Conditions Medium: diffusion: Mueller-Hinton agar (MHA) roth dilution: cation-adjusted Mueller-Hinton
More informationAcute Otitis Media in Pediatric Medicine Current Issues in Epidemiology, Diagnosis, and Management
REVIEW ARTICLE Pediatr Drugs 2003; 5 Suppl. 1: 1-12 1174-5878/03/0001-0001/$30.00/0 Adis Data Information BV 2003. All rights reserved. Acute Otitis Media in Pediatric Medicine Current Issues in Epidemiology,
More informationB. PACKAGE LEAFLET 1
B. PACKAGE LEAFLET 1 PACKAGE LEAFLET NICILAN 400 mg/100 mg tablets for dogs 1. NAME AND ADDRESS OF THE MARKETING AUTHORISATION HOLDER AND OF THE MANUFACTURING AUTHORISATION HOLDER RESPONSIBLE FOR BATCH
More informationCan levaquin treat group b strep
Can levaquin treat group b strep The Borg System is 100 % Can levaquin treat group b strep IBS - Symptoms, Diet and Treatment. IBS, is the common slang term or abbreviation for Irritable Bowel Syndrome
More informationAntibiotics (2): - Before you start: this lecture has a lot of names and things get entangled together, but I
Antibiotics (2): - Before you start: this lecture has a lot of names and things get entangled together, but I have nothing to do but to write everything the Doctor mentioned. I hope it will be clear. -
More informationEinheit für pädiatrische Infektiologie Antibiotics - what, why, when and how?
Einheit für pädiatrische Infektiologie Antibiotics - what, why, when and how? Andrea Duppenthaler andrea.duppenthaler@insel.ch Limping patient local pain swelling tenderness warmth fever acute Osteomyelitis
More informationChoosing an Antibiotic
Principles of Antibiotic Use - The 6 Step Plan Robin J Green MBBCh, DCH, FC Paed, DTM&H, MMed, FCCP, PhD, Dip Allergy, FAAAAI Department of Paediatrics and Child Health 1 Choosing an Antibiotic Disease/Site
More information1. The preferred treatment option for an initial UTI episode in a 22-year-old female patient
1 Chapter 79, Self-Assessment Questions 1. The preferred treatment option for an initial UTI episode in a 22-year-old female patient with normal renal function is: A. Trimethoprim-sulfamethoxazole B. Cefuroxime
More informationAntimicrobial Susceptibility Patterns
Antimicrobial Susceptibility Patterns KNH SURGERY Department Masika M.M. Department of Medical Microbiology, UoN Medicines & Therapeutics Committee, KNH Outline Methodology Overall KNH data Surgery department
More informationOtitis Media. TOM PARTNER, NP suggestions
Otitis Media TOM PARTNER, NP suggestions Treat Children with Omnicef (cedinir) as first choice because of less likely allergic reaction 14 mg /kg/ d (Once a day x 10 days) but do not exceed total of 600
More informationAntibiotics 1. Lecture 8
Antibiotics 1 Lecture 8 Overview of antibiotics What am I treating? Viral, bacterial, fungal, mycobacterial, etc. Who am I treating? Host factors: age, genetic factors, co-morbidities (renal and liver
More informationEUCAST recommended strains for internal quality control
EUCAST recommended strains for internal quality control Escherichia coli Pseudomonas aeruginosa Staphylococcus aureus Enterococcus faecalis Streptococcus pneumoniae Haemophilus influenzae ATCC 59 ATCC
More informationAntimicrobial prescribing pattern in acute tonsillitis: A hospital based study in Ajman, UAE
Antimicrobial prescribing pattern in acute tonsillitis: A hospital based study in Ajman, UAE Lisha Jenny John 1*, Meenu Cherian 2, Jayadevan Sreedharan 3, Tambi Cherian 2 1 Department of Pharmacology,
More informationAntimicrobial Stewardship in Ambulatory Care
Antimicrobial Stewardship in Ambulatory Care Nila Suntharam, M.D. May 5, 2017 Dr. Suntharam indicated no potential conflict of interest to this presentation. She does not intend to discuss any unapproved/investigative
More informationMEDICATIONS MEXICO S DE R.L. DE C.V. Agrifen Acetaminophen Chlorpheniramine 40 # Amikacin Generic 500 mg 2ml 2 ampoules #
Agrifen Acetaminophen Chlorpheniramine 40 $10 tabs Amikacin Generic 500 mg 2ml 2 ampoules $11 inyectable Amoxil Amoxicillin 500 mg 12 Caps $20 Amoxil Amoxicillin Generic 500 mg 12 Caps $13 Amoxil Amoxicillin
More informationUTI Dr S Mathijs Department of Pharmacology
UTI Dr S Mathijs Department of Pharmacology Introduction Responsible for > 7 million consultations annually 15% of all antibiotic prescriptions 40% of all hospital acquired infections Significant burden
More informationVolume 2; Number 16 October 2008
Volume 2; Number 16 October 2008 What s new this month NHS Lincolnshire have launched a public information campaign designed to raise public awareness of the risks associated with the inappropriate use
More informationACUTE EXACERBATIONS of COPD (AE-COPD) : The Belgian perspective
ACUTE EXACERBATIONS of COPD (AE-COPD) : The Belgian perspective Antwerpen 8 november 2002 Yvan Valcke MD PhD AZ Maria Middelares Sint-Niklaas ACUTE EXACERBATIONS of COPD (AE-COPD) Treatment of AECB Role
More informationOutpatient Antimicrobial Therapy. Role of Antibacterials in Outpatient Treatment of Respiratory Tract Infection. Vicks VapoRub
Outpatient Antimicrobial Therapy B. Joseph Guglielmo, Pharm.D. Professor and Chair Department of Clinical Pharmacy University of California San Francisco Role of Antibacterials in Outpatient Treatment
More information3/23/2017. Kathryn G. Smith, PharmD PGY1 Pharmacy Resident Via Christi Hospitals Wichita, Inc. Kathryn G. Smith: Nothing to disclose
Kathryn G. Smith, PharmD PGY1 Pharmacy Resident Via Christi Hospitals Wichita, Inc Kathryn G. Smith: Nothing to disclose Describe the new updates and rationale for them Relay safety concerns with use of
More informationCONTAGIOUS COMMENTS Department of Epidemiology
VOLUME XXIII NUMBER 1 July 2008 CONTAGIOUS COMMENTS Department of Epidemiology Bugs and Drugs Elaine Dowell, SM (ASCP), Marti Roe SM (ASCP), Ann-Christine Nyquist MD, MSPH Are the bugs winning? The 2007
More informationPHAMACOLOGY 2 nd EXAM QUESTIONS 2012/2013
PHAMACOLOGY 2 nd EXAM QUESTIONS 2012/2013 1.from the pharmacological point of view, which of the following intervention is correct? a) treating postpartum non-obstructive urinary retention by intramuscular
More informationKeywords: amoxicillin/clavulanate, respiratory tract infection, antimicrobial resistance, pharmacokinetics/pharmacodynamics, appropriate prescribing
Journal of Antimicrobial Chemotherapy (2004) 53, Suppl. S1, i3 i20 DOI: 10.1093/jac/dkh050 Augmentin (amoxicillin/clavulanate) in the treatment of community-acquired respiratory tract infection: a review
More informationJanuary 2014 Vol. 34 No. 1
January 2014 Vol. 34 No. 1. and Minimum Inhibitory Concentration (MIC) Interpretive Standards for Testing Conditions Medium: diffusion: Mueller-Hinton agar (MHA) Broth dilution: cation-adjusted Mueller-Hinton
More informationConsiderations in antimicrobial prescribing Perspective: drug resistance
Considerations in antimicrobial prescribing Perspective: drug resistance Hasan MM When one compares the challenges clinicians faced a decade ago in prescribing antimicrobial agents with those of today,
More informationAmoxicillin Introduction: Mechanism of action: Pharmacology: Indications: Dosage: 12 Weeks ( 3 Months):
Amoxicillin Introduction: A semisynthetic antibiotic, an analog of ampicillin, with a broad spectrum of bactericidal activity against many gram-positive and gram-negative microganisms. Mechanism of action:
More informationInfectious Disease Update: The latest adult treatment recommendations
Infectious Disease Update: The latest adult treatment recommendations Margaret Fitzgerald, DNP, FNP-BC, NP-C, FAANP, CSP, FAAN, DCC President, Fitzgerald Health Education Associates, Inc. North Andover,
More informationMOLINA HEALTHCARE OF CALIFORNIA
MOLINA HEALTHCARE OF CALIFORNIA Upper Respiratory Infection (URI) GUIDELINE Summaries for Adults and Pediatrics. The guideline was reviewed and adopted by the Molina Healthcare of California Clinical Quality
More information