GetSmartAboutAntibiotics.AnIntroductiontoPrudentAntibioticUse.pptVIP

Note: The two scenarios in which the treatment of asymptomatic bacteriuria is appropriate are: pregnancy and patients undergoing a urologic procedure for which bleeding is anticipated. Additional examples of non-infectious causes of pulmonary infiltrates: Heart failure, pulmonary embolism, pulmonary effusions, chronic fibrosis Role of bacteria in acute bronchitis is minimal. Mostly due to viral infections of the upper airways including: influenza A and B, parainfluenza, coronavirus, rhinovirus, respiratory syncytial virus, and human metapneumovirus. Note: May want to make a point that acute bronchitis is different from acute exacerbations of chronic bronchitis which in some situations have better outcomes on antibiotics. Use of biomarkers of inflammation (e.g. procalcitonin) is an emerging area in antibiotic stewardship Summary of Asymptomatic Bacteriuria Treatment Treat symptomatic patients with pyuria and bacteriuria Don’t treat asymptomatic patients with pyuria and/or bacteriuria Define the symptomatic infection anatomically Dysuria and frequency without fever equals cystitis Dysuria and frequency with fever, flank pain, and/or nausea and vomiting equals pyelonephritis Remember prostatitis in the male with cystitis symptoms CAP: often a difficult diagnosis X-rays can be difficult to interpret. Infiltrates may be due to non-infectious causes. Examples: Atelectasis Malignancy Hemorrhage Pulmonary edema Tenet 2: Do not Treat Sterile Inflammation or Abnormal Imaging Without InfectionExample: community-acquired pneumonia (CAP) Pneumonia is not present in up to 30% of patients treated Do not treat abnormal x-rays with antibiotics if the patient does not have systemic evidence of inflammation (fever, wbc, sputum production, etc) Discontinue antibiotics initially started for pneumonia if alternative diagnosis revealed Community-Acquired Pneumonia (CAP)  Acute bronchitis Common colds Sinusitis with symptoms less than 7 days Sinusitis not localized to the maxillary s