Appropriate Antibiotic Prescribing: Making Good Choices for Bad Bugs. Disclosure 4/22/17
|
|
- Beryl Bates
- 5 years ago
- Views:
Transcription
1 Appropriate Antibiotic Prescribing: Making Good Choices for Bad Bugs Elizabeth O. Hand, Pharm.D., BCPS Pediatric Infectious Disease Pharmacist University Health System Clinical Assistant Professor The University of Texas at Austin College of Pharmacy Disclosure I have nothing to disclose regarding the content of this presentation. Antibiotics are the only medication in which use in one patient can affect outcomes in another. 1
2 This image cannot currently be This image cannot currently be This image cannot currently be Not a Lot on the Horizon This image cannot currently be This image cannot currently be This image cannot currently be 2
3 Infections More Deadly Than Cancer?! This image cannot currently be Objectives Describe recent trends in antimicrobial resistance in the United States List three common bacterial pathogens seen in the primary care setting and available treatment options Explain unintentional consequences of inappropriate antibiotic prescribing Identify ways to improve appropriate antibiotic prescribing in clinical practice By The Numbers million antibiotic prescriptions annually 30-50% inappropriate >60% of expenditures in outpatient setting 80-90% of antibiotic volume in humans Most common antibiotics Azithromycin and amoxicillin 3
4 U.S. Outpatient Antibiotic Prescribing This image cannot currently be NEJM 2013; 368(15) What is Appropriate Antibiotic Prescribing? Using antibiotics to treat a bacterial infection Using the narrowest spectrum agent(s) needed to cover possible or known pathogens Using antibiotics for the shortest time possible Backed by the highest level of efficacy data available to treat the infection in question ANYTHING ELSE IS INAPPROPRIATE Adapted from slide presentation by Dr. Brad Spellberg, SIDP Presentation, Boston, MA 2016 What Are YOUR Biggest Challenges? This image cannot currently be 4
5 Challenges in the Outpatient Setting Lack of culture-driven therapy Viral vs. bacterial Fully susceptible vs. fully resistant Lack of knowledge or misconceptions about resistance Majority of providers unable to describe local trends Limited oral antibiotic options Perception antibiotics are benign Antibiotic Resistance Threats in the United States, CDC 2013 Report This image cannot currently be 1. Drug-resistant Streptococcus pneumoniae 2. Extended-spectrum beta lactamase producing Enterobacteriaceae (ESBLs) a. E.coli 3. MRSA Antibiotic Resistance Porin Deletion Altered Binding Site This image cannot currently be Efflux Enzymatic Breakdown 5
6 Most Common Reasons for Antibiotics Respiratory tract infections Urinary tract infections Skin/soft tissue infections Principles of Empiric Antibiotic Prescribing Presumed activity against >90% of isolates Most benign side effect profile Supported by clinical evidence Affordable for patient *Balancing potential risks vs. potential benefit* Most Common Reasons for Antibiotics Respiratory tract infections Pathogen of concern: Streptococcus pneumoniae Urinary tract infections Pathogen of concern: E.coli Skin/soft tissue infections Pathogen of concern: Staphylococcus aureus 6
7 Bacterial Respiratory Tract Infections Pharyngitis due to Streptococcus pyogenes (Group A streptococcus) Sometimes bacterial Community acquired pneumonia (CAP) Acute bacterial rhinosinusitis Acute otitis media (AOM) NOT BRONCHITIS Epidemiology of CAP This image cannot currently be 2% Jain S et al. NEJM 2015; 373: Streptococcus pneumoniae 4 million infections 22,000 deaths annually Most common bacterial cause of CAP Meningitis AOM? Immunization WORKS This image cannot currently be CDC, Antibiotic Resistance Threats in the United States,
8 Pneumococcal Conjugate Vaccine Impact PCV13 contains polysaccharides from pneumococcal serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F, and 23F Efficacy Rates Evaluation of 3232 visits for suspected pneumonia or invasive disease 46% for first episode of vaccine-type CAP This image 75% for cannot vaccine-type currently be invasive disease N Engl J Med 2015;372: Pneumococcal Conjugate Vaccine Impact in Pediatrics This image cannot currently be This image cannot currently be J Pediatric Infect Dis Soc Feb 22. ACIP Recommendations for PCV13 Children Four dose series at 2, 4, 6 and months Adults >65 years Single dose followed by PPSV23 Adults >19 with immunocompromising conditions Single dose followed by PPSV23 8
9 Risk Factors For Pneumonia Smoking Poor oral hygiene or prosthesis Malnutrition Dust exposure in work place Oropharyngeal dysphagia Contact with children Nonvaccination against S.pneumoniae PPSV23 vs. PCV13 Clin Pulm Med 2016; 23: Guideline Recommended Regimens for CAP Previously healthy, no antibiotics in prior 3 months Macrolide (à azithromycin) Doxycycline Significant comorbidities (DM, alcoholism, malignancy, asplenia, etc), use of antibiotics in prior 3 months Respiratory fluoroquinolone (levo, moxi) Beta lactam (amoxicillin) plus a macrolide Clin Infect Dis 2007; 44: S Macrolides Azithromycin Oral 100% bioavailable Once daily dosing Fairly benign side effect profile Active against atypical pathogens, some S.pneumoniae A wolf in sheep s clothing? Driver of penicillin resistance in S.pneumoniae Concern for increased risk of sudden cardiac death NEJM 2012; 366: Clin Infect Dis 2011;53(7):
10 FDA Drug Safety Communication: Fluoroquinlones Health care professionals should not prescribe systemic fluoroquinolones to patients who have other treatment options for acute bacterial sinusitis, acute bacterial exacerbation of chronic bronchitis, and uncomplicated urinary tract infections because the risks outweigh the benefits in these patients. FDA Drug Safety Communication, Safety Announcement, July Reliable Antibiotics for S.pneumoniae in CAP First line Penicillin, amoxicillin Amoxicillin-clavulanic acid Second line Cefdinir Cefuroxime Third line Respiratory fluoroquinolones Sinusitis: Treatment This image cannot currently be IDSA Clinical Practice Guidelines for Acute Bacterial Rhinos inus itis in Children and Adults. Clin Infect Dis
11 This Acute image Sinusitis: cannot currently Treatment be AZITHROMYCIN NOT RECOMMENDED FOR SINUSITIS DUE TO HIGH LEVELS OF RESISTANCE IN STREPTOCOCCUS PNEUMONIAE IDSA Clinical Practice Guidelines for Acute Bacterial Rhinos inus itis in Children and Adults. Clin Infect Dis Respiratory Infections: Take Home Points Most are viral Sick contacts are a clue If bacterial, mostly Streptococcus pneumoniae Macrolide resistance is increasing High dose amoxicillin is the most reliable option Fluoroquinolones as a last resort Most Common Reasons for Antibiotics Respiratory tract infections Pathogen of concern: Streptococcus pneumoniae Urinary tract infections Pathogen of concern: E.coli Skin/soft tissue infections Pathogen of concern: Staphylococcus aureus 11
12 E.coli Major cause of uncomplicated urinary tract infections and pyelonephritis Highly susceptible to multi-drug resistant Godzilla bug Antibiotic therapy should use a combination of the antibiogram and past antibiotic exposure This image cannot currently be Have You Recently Traveled to India? E.coli 83% resistance to ceftriaxone 84% resistance to fluoroquinolones 11% resistance to carbapenems CCEDP Resistance Map, This image cannot currently be 12
13 E.Coli in San Antonio % susceptible Amoxicillin 44 Ampicillin-sulbactam 54 Cefazolin 83 Cefpodoxime 84 SMX/TMP 65 Ciprofloxacin 75 Nitrofurantoin 93 Susceptible based on ability to clear a systemic infection Oral Empiric Options for E.coli Nitrofurantoin Only uncomplicated cystitis Sulfamethoxazole/tri methopri m Ciprofloxacin, levofloxacin Oral third generation cephalosporins Cefpodoxime, cefdinir $$$ Fosfomycin 3 gram single dose (aka the Fosfo bomb ) $$$ Which Agent is Best? This image cannot currently be Possibly algorithm First uncomplicated UTI? Nitrofurantoin First complicated UTI Send for culture Ciprofloxacin Repeat UTIs Send for culture JAMA 2014;312(16): Early clinical and bacterial cure >~90% for most regimens 13
14 Beware Asymptomatic Bactiuria Diagnosis of UTI Symptoms (aka dysuria) + positive culture Symptoms + positive urinalysis Discharge + dysuria? Don t forget sexually transmitted diseases Only treat asymptomatic bactiuria in SPECIFIC populations Pregnant women, those underlying GI/GU surgery, immunosuppressed patients (+/-) Urinary Tract Infections: Take Home Points E.coli is a problem Resistance increasing with no signs of slowing down MDR pathogens becoming more common in the community Reserve broader spectrum agents for second UTI or more complicated cases Nitrofurantoin preferred first line Send for culture, even though results are delayed Most Common Reasons for Antibiotics Respiratory tract infections Pathogen of concern: Streptococcus pneumoniae Urinary tract infections Pathogen of concern: E.coli Skin/soft tissue infections Pathogen of concern: Staphylococcus aureus 14
15 Staphylococcus aureus Gram positive cocci Three flavors Penicillin susceptible Methicillin susceptible (MSSA) Methicillin resistant (MRSA) Varying mechanisms of resistance Penicillin susceptible à penicillin resistant Beta lactamase production Methicillin susceptible à methicillin resistant Alteration in binding site MRSA aka THE KING Colonizes ~ 30% of US populations >80,000 invasive infections annually Bacteremia, endocarditis, pneumonia, bone and joint infections >11,000 deaths Why is MRSA so much worse? This image cannot currently Clin Microbiol Rev 2015; 28(3): How We Got Here 1960 First MRSA isolate identified 1981 MRSA outbreak amongst IVDU in Detroit fold increase in rate of hospitalizatio ns due to MRSA in patients with no risk factors MRSA infections in US academic centers double Increase in ED visits due to MRSA SSTIs from 1.2 to 3.4 million University of Chicago MRSA Research Center a-researc h-center.bsd. uchicag o.ed u/tim eline. ht ml 15
16 70 The Emergence of MRSA Prevalence All pts ICU UH Inpts UH Outpts Ann Clin Microbiol Antimicrob 2006 UHS Antibiograms MRSA in Recent Years Significant reductions in MRSA bacteremia since % reduction in hospital-associated MRSA infections Possible slight reduction in MRSA skin/soft tissue infections in the last decade Morbidity and mortality remain high Where Are We Now? Community onset MRSA ~40-45% of all S.aureus infections Common cause of skin/soft tissue infections Rare cause of community-acquired pneumonia <1% Can affect anyone, certain risk factors do exist IVDU, hemodialysis, FQ use? 16
17 MRSA by Age This image cannot currently be Guidelines for SSTI Management This image cannot currently be IDSA Guidelines for Management of SSTIs, MRSA Management Vancomycin Preferred agent for severe, invasive infections requiring intravenous therapy Oral antibiotic options Sulfamethoxazole/trimethoprim Doxycyline Minocycline Clindamycin Linezolid 17
18 Oral Options for MRSA Highly active in vitro (>95%) Sulfamethoxazole/trimethoprim Sulfa allergy, rash, hyperkalemia Linezolid Drug interactions (SSRIs), peripheral and optic neuropathy, bone marrow suppression, wallet toxicity Doxycyline, minocycline GI upset, binding of divalent cations Modest activity (60-70%) Clindamycin C.difficile associated diarrhea New Kids on the Block Dalbavancin, oritavancin Intravenous agents with activity against MRSA Approved in 2014 for acute bacterial skin/skin structure infections Half lives range from days 1 to 2 dose regimens $$$$$ Jury still out on clinical utility This image cannot currently be Nothing Kills like a Beta Lactam IDSA Guidelines for Management of SSTIs,
19 Avoidable Antibiotic Exposure in SSTIs Retrospective cohort study in Colorado 364 cases (pediatric and adult) 155 cellulitis, 168 abscess 139 cases of drained abscesses Antibiotics given in 80% of cases Average 7 day duration Overall 46% of all antibiotic use was deemed AVOIDABLE Am J Med 2013; 126(12) Skin Soft Tissue Infections: Take Home Points Purulence? à think Staphylococcus aureus IF an antibiotic is needed, cover for MRSA SMX/TMP, doxycycline, linezolid Non-purulent Cephalexin Clindamycin Five days is enough Tips on Picking the Right Drug DRUG BUG Interaction evaluated in the microbiology lab Effect of drug on bug at a set concentration Static interaction ONE PIECE OF THE PUZZLE 19
20 DRUG BUG DOUG Wrapping Up Antibiotics are a shared resource Most antibiotic prescribing occurring in the outpatient setting Limited development in new antibiotics Knowing your resistant pathogens and treatment options is key CDC 12 Steps to Reducing Antibiotic Resistance 1. Vaccinate 2. Get the catheters out 3. Target the pathogen 4. Access the experts 5. Practice antimicrobial control 6. Use local data 7. Treat infection, not contamination 8. Treat infection, not colonization 9. Know when to say no to vanco 10. Stop treatment when infection is cured or unlikely 11. Isolate the pathogen 12. Contain the contagion 20
21 This image cannot currently be This image cannot currently be VS. This image cannot currently be Thank you! 21
Antibiotic 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 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 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 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 informationGuidelines for Treatment of Urinary Tract Infections
Guidelines for Treatment of Urinary Tract Infections Overview This document details the Michigan Hospital Medicine Safety (HMS) Consortium preferred antibiotic choices for treatment of uncomplicated and
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 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 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 informationAntibiotic Updates: Part I
Antibiotic Updates: Part I 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 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 informationInfectious Disease 101: Helping the Consultant Pharmacist with Stewardship Principles
Infectious Disease 101: Helping the Consultant Pharmacist with Stewardship Principles Conflicts of Interest None at this time May be discussing off-label indications KALIN M. CLIFFORD, PHARM.D., BCPS,
More informationAntimicrobial Stewardship
Antimicrobial Stewardship Antimicrobial Stewardship Studies have estimated that 30 50% of antibiotics prescribed in acutecare hospitals are unnecessary or inappropriate 1 Antimicrobial stewardship definition:
More informationNorthwestern Medicine Central DuPage Hospital Antimicrobial Criteria Updated 11/16/16
Northwestern Medicine Central DuPage Hospital Antimicrobial Criteria Updated 11/16/16 These criteria are based on national and local susceptibility data as well as Infectious Disease Society of America
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 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 informationAntimicrobial stewardship: Quick, don t just do something! Stand there!
Antimicrobial stewardship: Quick, don t just do something! Stand there! Stanley I. Martin, MD, FACP, FIDSA Director, Division of Infectious Diseases Director, Antimicrobial Stewardship Program Geisinger
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 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 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 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 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 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 Stewardship Program (ASP) CHRISTUS SETX
Antibiotic Stewardship Program (ASP) CHRISTUS SETX Program Goals I. Judicious use of antibiotics Decrease use of broad spectrum antibiotics and deescalate use based on clinical symptoms Therapeutic duplication:
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 informationCHAPTER:1 THE RATIONAL USE OF ANTIBIOTICS. BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY
CHAPTER:1 THE RATIONAL USE OF ANTIBIOTICS BY Mrs. K.SHAILAJA., M. PHARM., LECTURER DEPT OF PHARMACY PRACTICE, SRM COLLEGE OF PHARMACY Antibiotics One of the most commonly used group of drugs In USA 23
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 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 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 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 informationSkin and Soft Tissue Infections Emerging Therapies and 5 things to know
2011 MFMER slide-1 Skin and Soft Tissue Infections Emerging Therapies and 5 things to know Aaron Tande, MD Assistant Professor of Medicine October 27, 2017 Division of INFECTIOUS DISEASES 2011 MFMER slide-2
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 informationStaph Cases. Case #1
Staph Cases Lisa Winston University of California, San Francisco San Francisco General Hospital Case #1 A 60 y.o. man with well controlled HIV and DM presents to clinic with ten days of redness and swelling
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 informationAppropriate antimicrobial therapy in HAP: What does this mean?
Appropriate antimicrobial therapy in HAP: What does this mean? Jaehee Lee, M.D. Kyungpook National University Hospital, Korea KNUH since 1907 Presentation outline Empiric antimicrobial choice: right spectrum,
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 informationObjectives 4/26/2017. Co-Investigators Sadie Giuliani, PharmD, BCPS Claude Tonnerre, MD Jayme Hartzell, PharmD, MS, BCPS
IMPLEMENTATION AND ASSESSMENT OF A GUIDELINE-BASED TREATMENT ALGORITHM FOR COMMUNITY-ACQUIRED PNEUMONIA (CAP) Lucas Schonsberg, PharmD PGY-1 Pharmacy Practice Resident Providence St. Patrick Hospital Missoula,
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 informationApproach 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 informationHow Low Can We Go? Readdressing Antibiotic Duration for Common Childhood Infections
How Low Can We Go? Readdressing Antibiotic Duration for Common Childhood Infections Rebecca Levorson, MD Andrew Nuibe, MD, MSCI Pediatric Infectious Diseases Disclosures Dr. Rebecca Levorson: I have no
More informationANTIMICROBIAL STEWARDSHIP: ADVANCING PATIENT CARE BY IMPROVING MEDICATION USE
ANTIMICROBIAL STEWARDSHIP: ADVANCING PATIENT CARE BY IMPROVING MEDICATION USE ANTHONY M. CASAPAO, PHARM.D. ASSISTANT PROFESSOR OF PHARMACY PRACTICE HUSSON UNIVERSITY SCHOOL OF PHARMACY CLINICAL INFECTIOUS
More information11/22/2016. Antimicrobial Stewardship Update Disclosures. Outline. No conflicts of interest to disclose
Antimicrobial Stewardship Update 2016 APIC-CI Conference November 17 th, 2016 Jay R. McDonald, MD Chief, ID Section VA St. Louis Health Care System Assistant Professor of medicine Washington University
More informationIMPLEMENTATION AND ASSESSMENT OF A GUIDELINE-BASED TREATMENT ALGORITHM FOR COMMUNITY-ACQUIRED PNEUMONIA (CAP)
IMPLEMENTATION AND ASSESSMENT OF A GUIDELINE-BASED TREATMENT ALGORITHM FOR COMMUNITY-ACQUIRED PNEUMONIA (CAP) Lucas Schonsberg, PharmD PGY-1 Pharmacy Practice Resident Providence St. Patrick Hospital Missoula,
More informationSafe Patient Care Keeping our Residents Safe Use Standard Precautions for ALL Residents at ALL times
Safe Patient Care Keeping our Residents Safe 2016 Use Standard Precautions for ALL Residents at ALL times #safepatientcare Do bugs need drugs? Dr Deirdre O Brien Consultant Microbiologist Mercy University
More informationAntibiotic stewardship in long term care
Antibiotic stewardship in long term care Shira Doron, MD Associate Professor of Medicine Division of Geographic Medicine and Infectious Diseases Tufts Medical Center Boston, MA Consultant to Massachusetts
More informationBest Practices: Goals of Antimicrobial Stewardship
Best Practices: Goals of Antimicrobial Stewardship Gail Scully, M.D, M.P.H. and Elizabeth Radigan, PharmD, BCPS UMass Memorial Medical Center Division of Infectious Disease Department of Medicine September
More informationAntimicrobial Update Stewardship in Primary Care. Clare Colligan Antimicrobial Pharmacist NHS Forth Valley
Antimicrobial Update Stewardship in Primary Care Clare Colligan Antimicrobial Pharmacist NHS Forth Valley Setting the Scene! Consequences of Antibiotic Use? Resistance For an individual patient with
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 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 informationAZITHROMYCIN, DOXYCYCLINE, AND FLUOROQUINOLONES
AZITHROMYCIN, DOXYCYCLINE, AND FLUOROQUINOLONES Update in Medicine and Primary Care Whitney R. Buckel, PharmD, BCPS-AQ ID System Antimicrobial Stewardship Pharmacist Manager OBJECTIVES 1. List three antibiotics
More informationAntimicrobial Stewardship:
Antimicrobial Stewardship: Inpatient and Outpatient Elements Angela Perhac, PharmD afperhac@carilionclinic.org Disclosure I have no relevant finances to disclose. Objectives Review the core elements of
More informationDiscussion Points. Decisions in Selecting Antibiotics
Antibiotics in Acute Care Fredrick M. Abrahamian, D.O., FACEP, FIDSA Clinical Professor of Medicine UCLA School of Medicine Director of Education Department of Emergency Medicine Olive View-UCLA Medical
More informationAntimicrobial Update. Vicky Dudas, Pharm.D. Associate Clinical Professor of Pharmacy Director, Antimicrobial Management Program UCSF Medical Center
Antimicrobial Update Vicky Dudas, Pharm.D. Associate Clinical Professor of Pharmacy Director, Antimicrobial Management Program UCSF Medical Center Objectives Discuss treatment of acute bacterial rhinosinusitis
More information3/1/2016. Antibiotics --When Less is More. Most Urgent Threats. Serious Threats
Antibiotics --When Less is More Ralph Gonzales, MD, MSPH Associate Dean, Clinical Innovation School of Medicine VP, Clinical Innovation, UCSF Health Most Urgent Threats Serious Threats Multidrug-Resistant
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 informationAntibiotics in the trenches: An ER Doc s Perspective
Antibiotics in the trenches: An ER Doc s Perspective Peter Currie, MD Medical Director for Quality Emergency Physicians Professional Association (EPPA) Agenda Emergency Medicine Specific Disease Processes
More information9/30/2016. Dr. Janell Mayer, Pharm.D., CGP, BCPS Dr. Lindsey Votaw, Pharm.D., CGP, BCPS
Dr. Janell Mayer, Pharm.D., CGP, BCPS Dr. Lindsey Votaw, Pharm.D., CGP, BCPS 1 2 Untoward Effects of Antibiotics Antibiotic resistance Adverse drug events (ADEs) Hypersensitivity/allergy Drug side effects
More informationPRACTIC GUIDELINES for APPROPRIATE ANTIBIOTICS USE
PRACTIC GUIDELINES for APPROPRIATE ANTIBIOTICS USE Global Alliance for Infection in Surgery World Society of Emergency Surgery (WSES) and not only!! Aims - 1 Rationalize the risk of antibiotics overuse
More informationPresenter: Marc Meyer, BPharm, RPh, CIC, FAPIC Clinical Pharmacists, Infection Preventionist, Antibiotic Stewardship Pharmacist Southwest Health
Presenter: Marc Meyer, BPharm, RPh, CIC, FAPIC Clinical Pharmacists, Infection Preventionist, Antibiotic Stewardship Pharmacist Southwest Health System, Cortez, Colorado None How do AU vendors and NHSN
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 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 information6/15/2017 PART 1: THE PROBLEM. Objectives. What is Antimicrobial Resistance? Conflicts of Interest Disclosure Statement
Conflicts of Interest Disclosure Statement Getting a grasp on Antibiotic Use and Resistance: Principles of Antimicrobial Stewardship Speaker has nothing to disclose. Jacob M Kesner, PharmD UNMH PGY-2 Infectious
More informationCefazolin vs. Antistaphyloccal Penicillins: The Great Debate
Cefazolin vs. Antistaphyloccal Penicillins: The Great Debate Annie Heble, PharmD PGY2 Pediatric Pharmacy Resident Children s Hospital Colorado Microbiology Rounds March 22, 2017 Image Source: Buck cartoons
More informationExamples of Antimicrobial Stewardship Interventions: a couple of starter projects
Examples of Antimicrobial Stewardship Interventions: a couple of starter projects Jennifer Ott, PharmD, BCPS Clinical Pharmacist Specialist Infectious Diseases Billings Clinic jott4@billingsclinic.org
More informationLifting the lid off CAP guidelines
Lifting the lid off CAP guidelines Dr. Andrew M. Morris September 5, 2007 12:00-13:00 web.mac.com/idologist Objectives 1. To review the epidemiology of community-acquired pneumonia (CAP) 2. To explore
More informationDisclosures. Principles of Antimicrobial Therapy. Obtaining an Accurate Diagnosis Obtain specimens PRIOR to initiating antimicrobials
Disclosures Principles of Antimicrobial Therapy None Lori A. Cox MSN, ACNP-BC, ACNPC, FCCM Penn State Hershey Medical Center Neuroscience Critical Care Unit Obtaining an Accurate Diagnosis Determine site
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 informationImagine. Multi-Drug Resistant Superbugs- What s the Big Deal? A World. Without Antibiotics. Where Simple Infections can be Life Threatening
Multi-Drug Resistant Superbugs- What s the Big Deal? Toni Biasi, RN MSN MPH CIC Infection Prevention Indiana University Health Imagine A World Without Antibiotics A World Where Simple Infections can be
More informationGET SMART Clinician-Patient Communication about Antibiotics
GET SMART Clinician-Patient Communication about Antibiotics Wednesday, May 23, 11:30 12:30 Webinar Will Begin Shortly. Slides may be downloaded at: http://www.healthcarefornewengland.org/event/getsmart_abx/
More informationDISCLAIMER: ECHO Nevada emphasizes patient privacy and asks participants to not share ANY Protected Health Information during ECHO clinics.
DISCLAIMER: Video will be taken at this clinic and potentially used in Project ECHO promotional materials. By attending this clinic, you consent to have your photo taken and allow Project ECHO to use this
More informationChallenges Emerging resistance Fewer new drugs MRSA and other resistant pathogens are major problems
Micro 301 Antimicrobial Drugs 11/7/12 Significance of antimicrobial drugs Challenges Emerging resistance Fewer new drugs MRSA and other resistant pathogens are major problems Definitions Antibiotic Selective
More informationSource: Portland State University Population Research Center (
Methicillin Resistant Staphylococcus aureus (MRSA) Surveillance Report 2010 Oregon Active Bacterial Core Surveillance (ABCs) Office of Disease Prevention & Epidemiology Oregon Health Authority Updated:
More informationHost, Syndrome, Bug, Drug: Introducing 2 Frameworks to Approach Infectious Diseases Cases with an Antimicrobial Stewardship Focus
Host, Syndrome, Bug, Drug: Introducing 2 Frameworks to Approach Infectious Diseases Cases with an Antimicrobial Stewardship Focus Montana ACP Meeting 2018 September 8, 2018 Staci Lee, MD, MEHP Billings
More informationECHO: Management of URIs. Charles Krasner, M.D. Sierra NV Veterans Affairs Hospital University of NV, Reno School of Medicine October 16, 2018
ECHO: Management of URIs Charles Krasner, M.D. Sierra NV Veterans Affairs Hospital University of NV, Reno School of Medicine October 16, 2018 Infectious causes of URIs change over time Most ARIs are viral
More informationAntimicrobial Stewardship Programs The Same, but Different. Sara Nausheen, MD Kevin Kern, PharmD
Antimicrobial Stewardship Programs The Same, but Different Sara Nausheen, MD Kevin Kern, PharmD Antimicrobial Stewardship Programs The Same, but Different Objectives: Outline the overall function of an
More informationEvaluating the Role of MRSA Nasal Swabs
Evaluating the Role of MRSA Nasal Swabs Josh Arnold, PharmD PGY1 Pharmacy Resident Pharmacy Grand Rounds February 28, 2017 2016 MFMER slide-1 Objectives Identify the pathophysiology of MRSA nasal colonization
More informationThe Rise of Antibiotic Resistance: Is It Too Late?
The Rise of Antibiotic Resistance: Is It Too Late? Paul D. Holtom, MD Professor of Medicine and Orthopaedics USC Keck School of Medicine None DISCLOSURES THE PROBLEM Antibiotic resistance is one of the
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 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 informationS aureus infections: outpatient treatment. Dirk Vogelaers Dept of Infectious Diseases University Hospital Gent Belgium
S aureus infections: outpatient treatment Dirk Vogelaers Dept of Infectious Diseases University Hospital Gent Belgium Intern Med J. 2005 Feb;36(2):142-3 Intern Med J. 2005 Feb;36(2):142-3 Treatment of
More informationOptimize Durations of Antimicrobial Therapy
Optimize Durations of Antimicrobial Therapy Evidence & Application Jill Cowper, Pharm.D. Division Infectious Diseases Pharmacist Parallon Supply Chain Solutions Richmond, VA P: 607 221 5101 jill.butterfield@parallon.com
More informationMeropenem for all? Midge Asogan ICU Fellow (also ID AT)
Meropenem for all? Midge Asogan ICU Fellow (also ID AT) Infections Common reason for presentation to ICU Community acquired - vs nosocomial - new infection acquired within hospital environment Treatment
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 informationAntibiotic Stewardship in Human Health- Progress and Opportunities
National Center for Emerging and Zoonotic Infectious Diseases Antibiotic Stewardship in Human Health- Progress and Opportunities CAPT Lauri A. Hicks, D.O. Director, Office of Antibiotic Stewardship Division
More informationWhat s next in the antibiotic pipeline?
What s next in the antibiotic pipeline? Jennifer Tieu, Pharm.D., BCPS Clinical Pearls OSHP Spring Meeting Mercy Hospital April 13, 2018 Objective 2 Describe the drug class and mechanism of action of antibiotics
More informationAntimicrobial Chemotherapy
2016 edition by Claudine El-Beyrouty, PharmD, BCPS Department of Pharmacy Thomas Jefferson University Hospital Brian Roslund, PharmD, BCPS, AQ-ID Department of Pharmacy Thomas Jefferson University Hospital
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 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 information1. List three activities pharmacists can implement to support. 2. Identify potential barriers to implementing antimicrobial
OPTIMIZING ANTIMICROBIAL STEWARDSHIP: IT STARTS IN THE EMERGENCY DEPARTMENT! 1 2 Objectives 1. List three activities pharmacists can implement to support health-system antimicrobial stewardship programs
More informationGeneral Approach to Infectious Diseases
General Approach to Infectious Diseases 2 The pharmacotherapy of infectious diseases is unique. To treat most diseases with drugs, we give drugs that have some desired pharmacologic action at some receptor
More informationHigh Risk Emergency Medicine. Antibiotic Pitfalls
High Risk Emergency Medicine Antibiotic Pitfalls David, MD MS Assistant Professor Department of Emergency Medicine University of California, San Francisco I. Antibiotic Resistance Development of resistance
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 informationDisclosures. Nothing Medically I own FiPhysician LLC, a financial planning and investment company (FiPhysician.com)
"How to work around (with) administration to build an Antimicrobial Stewardship Program AND how to get dumb (oops reluctant) doctors to do the right thing" David Graham, MD Disclosures Nothing Medically
More informationAntimicrobial Pharmacodynamics
Antimicrobial Pharmacodynamics November 28, 2007 George P. Allen, Pharm.D. Assistant Professor, Pharmacy Practice OSU College of Pharmacy at OHSU Objectives Become familiar with PD parameters what they
More informationFor analyst certification and disclosures please see page 7
Physician Survey Survey of Healthcare Professionals on Community-Acquired Bacterial Pneumonia We conducted a survey on prescribing habits for community-acquired bacterial pneumonia (CABP) in order to better
More informationVaccination as a potential strategy to combat Antimicrobial Resistance in the elderly
Vaccination as a potential strategy to combat Antimicrobial Resistance in the elderly Wilbur Chen, MD, MS 22-23 March 2017 WHO meeting on Immunization of the Elderly The Problem Increasing consumption
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 informationIntra-Abdominal Infections. Jessica Thompson, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Clinical Specialist Renown Health April 19, 2018
Intra-Abdominal Infections Jessica Thompson, PharmD, BCPS (AQ-ID) Infectious Diseases Pharmacy Clinical Specialist Renown Health April 19, 2018 Select guidelines Mazuski JE, et al. The Surgical Infection
More informationCONTAGIOUS COMMENTS Department of Epidemiology
VOLUME XXIX NUMBER 3 November 2014 CONTAGIOUS COMMENTS Department of Epidemiology Bugs and Drugs Elaine Dowell SM MLS (ASCP), Marti Roe SM MLS (ASCP), Sarah Parker MD, Jason Child PharmD, and Samuel R.
More informationLe infezioni di cute e tessuti molli
Le infezioni di cute e tessuti molli SCELTE e STRATEGIE TERAPEUTICHE Pierluigi Viale Clinica di Malattie Infettive Policlinico S. Orsola Malpighi Treatment of complicated skin and skin structure infections
More informationObjective 1/20/2016. Expanding Antimicrobial Stewardship into the Outpatient Setting. Disclosure Statement of Financial Interest
Expanding Antimicrobial Stewardship into the Outpatient Setting Michael E. Klepser, Pharm.D., FCCP Professor Pharmacy Practice Ferris State University College of Pharmacy Disclosure Statement of Financial
More information