(精选)Prescribing Antibiotics in Pediatric Office Practice教学课件.pptVIP

Salmonella Typhi: Suspect only when fever of more than 4 days, without focus and primary reports suggestive MDR Strains still rampant Sensitivity to - 3rd gen cephalosporin – 98% - Quinolones* – 90-95% Always send Blood culture before starting antibiotics *Recently some centers from apex institutes less sensitivity Golden rules for Judicious use of antimicrobials Golden rule 1 Acute infection always presents with fever; in acute illness, absence of fever does not justify antibiotic Golden rule 2 Infection is the most common cause of fever in office practice, though not always bacterial infection - Viral infection in majority RTI - Viral infection should not be treated with antibiotic Golden rule 3 Clinical differentiation is possible between bacterial and viral infection most of the times Viral infection is disseminated throughout the system (URTI / LRTI) - May affect multiple systems - Fever is usually high at onset, settles by D3-4 - Child is comfortable and not sick during inter febrile state Bacterial infection is localized to one part of the system (acute tonsillitis does not present with running nose or chest signs) - Fever is generally moderate at the onset and peaks by D3-4 CBC does not differentiate between acute bacterial and viral infection Golden rule 4 Chronic infection may not be associated with fever and diagnosis can be difficult - Relevant laboratory tests are necessary - Antibiotic is considered only after observing progress - There is no need to hurry through antibiotic prescription Golden rule 5 Choose single oral antibiotic, either covering suspected gram positive or negative organism, as per site of infection and age of patient Combination of two antibiotics is justified only in serious bacterial infection without proof of specific organism and can be administered intravenously Golden rule 6 At first visit (w