Week 3 Study Guide.docx - Week 3 Study Guide[Antibiotic...

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Week 3 Study Guide [Antibiotic Drug Therapy] 1. Primary care: focus on organism specific treatment rather than broad spectrum treatment a. Reference CDC website to see current bacterial treatment, bacterial patterns in geographic location b. Patient education on viral vs bacterial antibiotic resistance (how we treat viral infection) i. 75-85% URI is viral vs bacterial c. Chapter 56 principles of prescribing ABX 2. Success a. Success of treating bacterial infection depends on achieving concentration at the site of infection that is sufficient to inhibit bacterial growth b. Culture your site i. All skin wounds, soft tissue wounds should be cultured ii. Simple urinary tract infection (UTI) s treated based on symptom and urinary dip stick septic Then Culture c. Look at your culture and sensitivity reports d. Base your judgement on H&P, symptoms, and knowledge base 3. Classes of bacteria a. Gram positive aerobes- Streptococcus and staphylococcus b. Gram positive anaerobes- Clostridium difficile (usually in GI tract) c. Gram negative aerobes – Neisseria gonorrhea, Haemophilus influenza, Moraxella caterrhalis, Enterobacteriaceae d. Gram negative anerobes – bacteroides fragilis 4. What could it be? a. Match your site with the suspected organism b. Usually i. Urinary: E Coli ii. Soft tissue: Staph, strep iii. GI- salmonella, shigella, H.pylori iv. Repiratory- pharyngitis – 85% are viral, then strep 1. Look at other signs a. Temperature b. Pus c. Positive lymph (infected lymph glands) v. Otitis- strep, H.flu, moraxella c. You may need to culture at times 5. Think Local a. Check with CDC, and local county health departments for local resistance/ sensitivities i. Especially for MRSA, STI, Respiratory, and Flu b. Gives local resistance patterns c. Especially important if you see patients in long term health facilities, corrections, schools 6. Actions on the bacterial cells a. Bactericidal- kill the bacteria directly or stop the infection. i. May be growth phases dependent 1. Growth phase of the bacteria b. Bacteriostatic- stop the bacteria from further cell division or slows protein synthesis, rely on the body’s immune system. i. We are starting to see lots of resistance 7. Antibiotic resistance a. Bacteria may be resistance if i. Drug failed to reach the target ii. Drug was inactivated (i.e., Caused by food)
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iii. Target was altered (i.e., bacteria changed itself) b. Types of Antibiotic resistance i. Innate resistance ii. Acquired resistance 8. Antibiotic- how they resist a. Chloramphenicol: reduced uptake into cell b. Tetracycline: active efflux from the cell c. Beta-lactams, erythromycin, lincomycin: eliminates or reduces binding of antibiotic to cell target d. Beta-lactams, aminoglycosides, chloramphenicol- enzymatic cleavage or modification to inactivate antibiotic molecule e. Sulfonamides, trimethoprim- metabolic bypass of inhibited reaction f. Sulfonamides, trimethoprim- overproduction of antibiotic target (titration) 9. Decreasing resistance a. Prevention- increase use of vaccines i. Pneumonia, flu, different viruses b. Diagnosis- correctly identifying infections c.
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